Abstract
Background: The aim of this study was to compare the incidence of post-procedural acute kidney injury (AKI) and other renal outcomes in patients undergoing transapical (TA) and transfemoral (TF) approaches for transcatheter aortic valve replacement (TAVR).Methods: All consecutive adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital were included. AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression adjustment, propensity score stratification, and propensity matching were performed to assess the independent association between procedural approach and AKI.Results: Of 366 included patients, 171 (47%) underwent TAVR via a TA approach. AKI occurrence in this group was significantly higher compared to the TF group (38% vs. 18%, p < .01). The TA approach remained significantly associated with increased risk of AKI after logistic regression (OR 3.20; CI 1.68–4.36) and propensity score adjustment: OR 2.83 (CI 1.66–4.80) for stratification and 3.82 (CI 2.04–7.44) for matching. Nonetheless, there was no statistically significant difference among the TA and TF groups with respect to major adverse kidney events (MAKE) or estimated glomerular filtration rate (eGFR) at six months post-procedure.Conclusion: In a cohort of patients undergoing TAVR for aortic stenosis, a TA approach significantly increases the AKI risk compared with a TF approach. However, the TAVR approach did not affect severe renal outcomes or long-term renal function.
Highlights
There was no significant difference in the need for renal replacement therapy (RRT), in-hospital mortality, major adverse kidney events (MAKE), stroke/TIA, vascular complication, six-month mortality, as well as estimated glomerular filtration rate (eGFR) at six months
Comprehensive propensity score analysis in a cohort of severe AS patients undergoing transcatheter aortic valve replacement (TAVR) was used to demonstrate a TA approach significantly increased the risk of acute kidney injury (AKI) compared to a TF approach with an overall 3.82fold increased the risk of AKI
Despite comparable patient populations in propensity score match analysis, TA-TAVR still carried a significantly higher AKI risk compared to TF-TAVR
Summary
Acute kidney injury (AKI) is relatively prevalent in patients undergoing transcatheter aortic valve replacement (TAVR).[1,2] It is independently associated with 30-day and 1-year mortality.[3,4] AKI after TAVR is associated with reported mortality rate as high as 55%.3–9 Potential risk factors for AKI after TAVR have already been identified, such as pre-existing chronic kidney disease (CKD), diabetes, contrast media exposure, hypotension, periprocedural bleeding, and blood transfusion.[2,3,5,10] Despite efforts to prevent AKI after TAVR, the incidence in patients with severe aortic stenosis following TAVR from 15 to 57%.3,5–7Transfemoral (TF) and transapical (TA) access approaches are the most commonly used approaches for TAVR. Patients undergoing TA-TAVR have been shown to have more complications, compared to patients undergoing TF-TAVR, including AKI and worse prognosis.[11,12,13,14,15,16,17,18] patients selected for TA-TAVR typically have higher comorbidities, especially peripheral vascular atherosclerotic diseases These results may be confounded by selection bias.[10,17]. The aim of this study was to compare the incidence of post-procedural acute kidney injury (AKI) and other renal outcomes in patients undergoing transapical (TA) and transfemoral (TF) approaches for transcatheter aortic valve replacement (TAVR). The TAVR approach did not affect severe renal outcomes or long-term renal function
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