Thorac Cardiovasc Surg 2012; 60 - V215
DOI: 10.1055/s-0031-1297605

Acute kidney injury after transcatheter aortic valve implantation: Frequency, prediction and its impact on 30-day and longterm mortality

K Gebauer 1, M Meyborg 1, N Malyar 1, G Kaleschke 2, G Kerckhoff 2, HH Scheld 3, H Baumgartner 2, H Reinecke 1
  • 1University Hospital Münster, Department of Cardiology and Angiology, Münster, Germany
  • 2Adult Congenital and Valvular Heart Disease Center Muenster, Münster, Germany
  • 3University Hospital Münster, Department of Thoracic and Cardiovascular Surgery, Münster, Germany

Objectives: Although transcatheter aortic valve implantation (TAVI) has become widely used in surgical high risk patients (pts) with aortic stenosis, complication rates and longterm mortality remain high. Chronic kidney disease is one of the most frequent comorbidities and implicates a high risk of postprocedural acute kidney injury (AKI). We analyzed its occurrence and impact on hospital stay, 30-day and longterm mortality.

Methods: The study population comprises 150 consecutive pts who underwent TAVI (transfemoral [TF] n=96, transapical [TA] n=54) in our institution (mean age 81±7 years; 69% females, logistic EuroSCORE 24±15%). AKI was defined as a creatinine rise of 0.3mg/dl or more within 48 hours after the procedure. Ten patients on chronic hemodialysis prior to TAVI had to be excluded. Median follow-up was 309 days.

Results: AKI occurred in 28 pts (19%) and was more frequent after TA (17 [31%]) than TF TAVI (11 [11%], p<0.0001). Baseline creatinine was slightly higher in AKI pts (1.43±0.67mg/dl vs. 1.23±0.51mg/dl), but this difference did not reach statistical significance (p=0.09). There was no difference between groups regarding the amount of contrast media used (AKI: 147±71ml, non-AKI 148±56ml, p=0.93).

Pts with AKI were significantly younger and had a higher rate of previous CABG and hypertension. There was however no significant difference in peripheral artery disease, diabetes mellitus, coronary artery disease and EuroSCORE. Both, 30-day-mortality (29% vs. 7%, p<0.0001) and longterm mortality (43% vs. 18%, p<0.0001) were markedly higher in pts with AKI. Hospital stay was significantly longer in pts with AKI (20±12 vs. 15±10 days). Predicted renal failure after open heart surgery calculated by the Society of Thoracic Surgeons Score was similar (5.8±3.6 [AKI] vs. 5.1±2.5 [non-AKI], p=0.24) and predicted markedly lower renal failure rates than observed in our study population.

Conclusion: Transcatheter aortic valve replacement is a promising alternative to conventional valve replacement for surgical high risk pts with aortic stenosis. However, AKI remains a frequent complication with markedly increased 30-day and longterm mortality. Careful identification of risk factors and development of more suitable risk scores as well as effective measures to reduce AKI after TAVI are essential.