Clinical impact of acute Kidney injury after Transcatheter Aortic Valve Implantation (TAVI) with the corevalve prosthesis in patients with aortic stenosis

Abstract

Acute Kidney Injury (AKI) after cardiac surgery is associated with increased mortality, but very few data exist on the ocurrence of AKI associated with Transcatheter Aortic Valve Implantation (TAVI). The objective of this study was to determine the incidence, predictors and prognosis of AKI after percutaneous implantation of the CoreValve aortic valve prosthesis. Methods: Between April 2008 and January 2011, 230 patients with severe aortic stenosis were treated with the CoreValve aortic valve prosthesis. The AKI was defined according to Valve set by the Academic Research Consortium, as the absolute increase in serum creatinine ≥0.3 mg/dl or an increase of over 50% at 72 hours a percutaneous procedure. Were excluded from analysis 7 patients, in 5 patients were unsuccessful procedural and 2 patients had chronic renal failure on dialysis. Results: Of the 223 patients treated with TAVI, 53 patients (23.8%) had chronic renal failure. AKI was identified in 37 patients (16.6%) and none reqired renal replacement therapy. After implantation there was a slight improvement in renal function, baseline serum creatinine decreased from 1.29±0.5 mg/dl to 1.22 mg/dl, P = 0.023 and Glomerular Filtration Rate (GFR) increased from 49.6±22 to 52±23, P = 0.015. There were no differences in the amount of contrast received (197±67 for patients with AKI vs. 180±72 cc for patients without AKI, P = 0.580). In patients with AKI, the mortality at 30 days was 13.5% compared to 1.6% of patients without AKI, P = 0.001 and late mortality after a mean of 16.7±11 months was 18.8% in those patients with AKI compared to 8.2% in those witout AKI, P = 0.068. In the multivariate analysis AKI was an independent predictor of cumulative total mortality (HR = 3.516, 95% CI from 1.098 to 11.255, P = 0.034). The factors associated with development of AKI were males and the presence of stroke prior the procedure. Conclusions: The deterioration of renal function in patients undergoing TAVI with the CoreValve prosthesis is a serious and frequent complication. The occurrence of AKI was associated with increase early mortality and also was a predictor of worse outcomes in the long-term follow-up.