150: The incidence, risk factors and prognosis of acute kidney injury (AKI) according to the valve academic research consortium (VARC) definition after transcatheter aortic valve implantation (TAVI)

Abstract

Few data are currently available about patients characteristics and procedural features associated with AKI after TAVI using the new recommended VARC definition. 99 patients underwent TAVI (1 procedural death, 78.8% transfemoral, 12.1% trans-apical/aortic and 9.1% subclavian access) between February 2009 and September 2011 at Rennes university hospital. Creatinine level was assessed daily at least up to 72 hours after TAVI. Patients’ characteristics, procedural features and outcomes according to VARC definitions were studied to evaluate determinants and prognostic impact of AKI. AKI occurred in 22 patients (22.2%). Among them, 5 were AKI 2 (5.1%), 8 were AKI 3 (9.1%) including 4 who needed dialysis (4%). At baseline, compared to no AKI or AKI 1, AKI 2 or 3 patients had a higher prevalence of moderate or severe chronic kidney disease (p=0.046) and ≥ grade 2 mitral regurgitation (p=0.03). During the post TAVI hospitalization, AKI 2 or 3 was associated to a higher rate of death from any cause (p=0.0009), major bleeding, acute heart failure (both p=0.002), infectious complications (p=0.0008) and longer total and ICU hospitalization duration (p=0.0004 and <0.0001 respectively). AKI 2 or 3 patients had a higher rate of 30-days and 6 months death from any cause (p=0.005 and p=0.0002 respectively) but only because of the deaths occurring during the initial hospitalization. Only AKI 3 was associated with a higher risk of 6-months NYHA class III or IV (p=0.016). AKI 2 or 3 as defined by the VARC criteria were associated with a higher risk of post procedural death because of their association with other major post procedural complications. AKI 3 was associated with a higher risk of short term worse functional outcomes. Figure 1: Time-to-event curv No AKI or AKI 1 N= 85 AKI 2 or 3 N=13 p value Age-yr 79.0 ±10.2 80.5±6.7 0.63 Logistic EuroSCORE 19.8±12.2 19.3±10.2 0.89 Left ventricular ejection fraction-% 48.2±14.4 58.1±12.5 0.02 Aortic valve area-cm 2 0.68±0.15 0.71±0.22 0.56