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Journal Article•DOI•

Acute Kidney Injury Following Aortic Valve Replacement in Patients Without Chronic Kidney Disease

Noriaki Moriyama1, Teemu Laakso1, Peter Raivio1, Sebastian Dahlbacka1, Eeva-Maija Kinnunen1, Tatu Juvonen1, Antti Valtola, Annastiina Husso, Maina P. Jalava2, Tuomas Ahvenvaara3, Tuomas Tauriainen3, Jarkko Piuhola3, Asta Lahtinen3, Matti Niemelä3, Timo H. Mäkikallio3, Marko Virtanen4, Pasi Maaranen4, Markku Eskola4, Mikko Savontaus2, Juhani Airaksinen2, Fausto Biancari2, Mika Laine1 •
University of Helsinki1, Turku University Hospital2, Oulu University Hospital3, University of Tampere4
01 Jan 2021-Canadian Journal of Cardiology (Elsevier)-Vol. 37, Iss: 1, pp 37-46
TL;DR: TAVR in patients without CKD was associated with a significantly less frequent incidence of AKI compared with SAVR, and increasing severity ofAKI was incrementally associated with 5-year mortality.
About: This article is published in Canadian Journal of Cardiology.The article was published on 2021-01-01 and is currently open access. It has received 7 citations till now. The article focuses on the topics: Kidney disease & Aortic valve replacement.

Summary (3 min read)

Jump to: [Introduction] – [Study design] – [Patient selection] – [Outcome measures] – [Statistical analysis] – [Results] – [Incidence and predictors of AKI] – [The effect of AKI on 5-years outcomes] – [Figure legends] and [RBC transfusion units]

Introduction

  • Acute kidney injury (AKI) is a common complication i patients undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), its incidence ranging up to 56% depending on the population.
  • 3,6,8 TAVR has become the preferred treatment strategy for severe aortic valve stenosis (AS) in patients at high and intermediat risk with a high prevalence of CKD3,9,10 and the incidence and clinical impact of AKI have been well documented in patients with CKD.
  • 11,12 During the past few years, the clinical practice with TAVR has shifted towards treating lower-risk patients deemed to have less frequent pre-procedural CKD.
  • Accordingly, knowledge of AKI and its impact on late outcomes in this subset of patients are essential before expanding the indication for TAVR to lower-risk patients with long life expectancy.
  • Therefore, the authors sought to investigate 1) he incidence and predictors of AKI, and 2) 5-year mortality in patients without pre-procedural CKD underwent TAVR or SAVR and 3) the impact of AKI and its severity on 5-year mortality.

Study design

  • The FinnValve registry is a nationwide registry, which includes retrospectively collected data from consecutive and unselected patients who underwent TAVR or SAVR with a bioprosthesis from 2008 to 2017 in Finland.
  • This study was approved by the Institutional Review Boards of each participating center.
  • The operative risk of the patients was evaluated according to the Society of Thoracic Surgeons (STS)18 and the EuroSCORE II19 risk scoring methods.
  • For the purpose of the current analysis, patients with baseline estimated glomerular filtration rate (eGFR)<60ml/min/1.73m2 according to the Modification of Diet in Renal Disea (MDRD) equation20 and dialysis were excluded.
  • Definition criteria of baseline risk factors Baseline variables were defined according to the EuroSCORE II criteria.19 Stratification of the severity of CKD was performed eGFR using the MDRD equation.

Patient selection

  • The registry includes data on 6463 patients who underwent TAVR or SAVR.
  • Pertinent to the present analysis, patients with CKD (n=1907) and those with missing values of serum creatinine (n=1) were excluded.
  • In 4555 patients (TAVR:n=1215; SAVR:n=3340) without CKD, a propensity-score (PS) matching between TAVR and SAVR groups was developed for comparative outcome analysis .

Outcome measures

  • The primary outcome of this study was to elucidate the incidence of post-operative AKI.
  • In the unmatched cohort, the incidence and predictors of AKI, and 5-year all-cause mortality in patients with or without AKI was evaluated.
  • In the matched cohort, the incidence of AKI was evaluated for the purpose of sensitivity analysis and 5-year all-cause mortality between TAVR and SAVR was analyzed.
  • 7 AKI was defined according to the KDIGO criteria,22 because it considers a time frame for creatinine changes of seven days, which usually is the average length of hospital day in patients undergoing SAVR (Supplementary Table S2).
  • Definitio criteria of the other outcomes are summarized in Supplementary Table S3.23,24.

Statistical analysis

  • Categorical variables were presented as counts and/or percentages and were compared using the chi-square test.
  • Continuous variables were present d as the mean ± standard deviation or median and interquartile range (25th-75th IQR) and were compared using the Student’s t-test or the Wilcoxon rank sum test based on their distributions.
  • One-to-one PS matching was performed employing the nearest neighbour method and a caliper width of 0.2 of the standard deviation of the logit of the estimated propensity core.
  • These tts were used to evaluate any difference in the adverse events of matched pairs.
  • Trends for the incide e of AKI over time was analyzed using the 8 Mantel-Haenszel linear-by-linear association chi-square test for trend.

Results

  • Patient characteristics and early outcomes A total of 4555 patients without pre-procedural CKD were the subjects of this analysis .
  • In the unmatched cohort, TAVR patients in comparison to SAVR patients were older and more often female, and had a higher predicted risk of operative mortality (Table 1).
  • During the study period, the proportion of SAVR decreased, whereas that of TAVR increased (Ptrend <0.001) .
  • The procedural characteristics and early outcomes are summarized in Table 3.

Incidence and predictors of AKI

  • In the unmatched series, the proportion of AKI in patients who underwent TAVR significantly decreased during the study period (Ptrend <0.001), but not in those who underwent SAVR (Ptrend =0.23) .
  • The results of multivariable analysis performed to identify predictors of AKI are shown in Table 4 and Supplementary Table S5.
  • The incidence of AKI was significantly increasing according to the severity of bleeding based on VARC-2 and E-CABG grade and increased units of RBC transfusion both in TAVR and SAVR cohort (P <0.001, respectively).

The effect of AKI on 5-years outcomes

  • Cumulative 5-year mortalities following TAVR or SAVR are displayed in Supplementary Figure S4.
  • On the other hand, among patients with intermediat to low surgical risk and lower prevalence of CKD, the incidence of AKI after TAVR decreased to less than 5%.
  • 10,13,14,27,28 5,31 Similarly, the cardiopulmonary bypass time and sever bleeding requiring blood transfusion affected worsening kidney function after SAVR in patients without CKD of the present study.
  • Secondly, even though PS matching resulted in sufficient balance of baseline characteristics, bias due to unknown or unmeasured confounders cannot be excluded.

Figure legends

  • (B) The right y-axis refers to the histogram of thenumber of patients with estimated glomerular filtration rate (eGFR) per 5 ml/min/1.732 increments.
  • Abbreviations as in Table 1 and Figure 1. (A) Cumulative event curves for all-cause death and l mark analysis from 3 month in total cohort.
  • Values are expressed as counts and percentages (in pare theses), mean±standard deviation.

RBC transfusion units

  • Values are expressed as counts and percentages (in pare theses).
  • All abbreviations as in Table 1-4. 45 Covariates included into these models are shown in Supplementary Table S6.

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Citations
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Journal Article•DOI•
Extravalvular Cardiac Damage and Renal Function Following Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis.

[...]

Michele Pighi1, Simone Fezzi1, Gabriele Pesarini1, Gabriele Venturi1, Davide Giovannini1, Gianluca Castaldi1, Mattia Lunardi1, Valeria Ferrero1, Roberto Scarsini1, Flavio Ribichini1 •
University of Verona1
01 Jun 2021-Canadian Journal of Cardiology
TL;DR: In this article, the differences in incidence of acute kidney injury (AKI) and acute kidney recovery (AKR) among patients undergoing transcatheter aortic valve implantation (TAVI), according to the degree of extravalvular cardiac damage (EVCD), were determined.

5 citations

Journal Article•DOI•
Acute Kidney Injury After Transcatheter Aortic Valve Replacement Mediates the Effect of Chronic Kidney Disease

[...]

04 Oct 2022-Journal of the American Heart Association
TL;DR: In this paper , the authors disentangle, applying mediation analysis, the association between acute kidney injury (AKI) and clinical outcome, considering CKD and bleeding complications in transcatheter aortic valve replacement (TAVR) patients.
Abstract: Background Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. However, it is controversial whether AKI affects prognosis per se, being linked to baseline chronic kidney disease (CKD) and bleeding complications. The aim of this study was to disentangle, applying mediation analysis, the association between AKI and clinical outcome, considering CKD and bleedings. Methods and Results Consecutive patients undergoing TAVR were prospectively enrolled at 5 high-volume centers in Italy. AKI was defined according to Valve Academic Research Consortium-3 consensus, whereas bleeding with Bleeding Academic Research Consortium. Primary outcome was all-cause mortality after 1-year follow-up. Among 2621 patients undergoing TAVR, AKI occurrence was associated with 1-year mortality. This association of AKI with the primary end points remained significant after adjusting for baseline risk estimators, either Society of Thoracic Surgeons score (hazard ratio [HR], 2.78 [95% CI, 1.95-3.80], P<0.001) or EuroSCORE-II (HR, 1.85 [95% CI, 1.35-2.56], P<0.001). Both AKI and CKD significantly and independently affected primary outcome (HR, 3.06 [95% CI, 2.01-4.64], P<0.001 and HR, 1.82 [95% CI 1.27-2.65], P<0.01, respectively). The estimated proportion of the total effect of CKD mediated via AKI was, on average, 15%, 95% CI, 4%-29%, P<0.001. The significant effect of Bleeding Academic Research Consortium 2-5 bleedings on the primary outcome was not mediated by AKI. Conclusions AKI occurs in 1 out of 6 patients and significantly mediates one fifth of the effect of baseline CKD on all-cause mortality after TAVR. Our analysis supports a systematic effort to prevent AKI during TAVR, which may potentially translate into improved patients' 1-year survival.

4 citations

Journal Article•DOI•
Acute Kidney Injury After Transcatheter Aortic Valve Replacement Mediates the Effect of Chronic Kidney Disease

[...]

Gabriele Crimi, Vincenzo De Marzo, Federico De Marco, Federico Conrotto, Jacopo Oreglia, Fabrizio D'Ascenzo, Luca Testa, Riccardo Gorla, Giuseppe Esposito, Sabato Sorrentino, Carmen Spaccarotella, Francesco Soriano, Francesco Bruno, Matteo Vercellino, Manrico Balbi, Nuccia Morici, Ciro Indolfi, Gaetano M. De Ferrari, Francesco Bedogni, Italo Porto 
29 Sep 2022-Journal of the American Heart Association
TL;DR: The analysis supports a systematic effort to prevent AKI during TAVR, which may potentially translate into improved patients' 1-year survival, and significantly mediates one fifth of the effect of baseline CKD on all-cause mortality after T AVR.
Abstract: Background Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. However, it is controversial whether AKI affects prognosis per se, being linked to baseline chronic kidney disease (CKD) and bleeding complications. The aim of this study was to disentangle, applying mediation analysis, the association between AKI and clinical outcome, considering CKD and bleedings. Methods and Results Consecutive patients undergoing TAVR were prospectively enrolled at 5 high‐volume centers in Italy. AKI was defined according to Valve Academic Research Consortium‐3 consensus, whereas bleeding with Bleeding Academic Research Consortium. Primary outcome was all‐cause mortality after 1‐year follow‐up. Among 2621 patients undergoing TAVR, AKI occurrence was associated with 1‐year mortality. This association of AKI with the primary end points remained significant after adjusting for baseline risk estimators, either Society of Thoracic Surgeons score (hazard ratio [HR], 2.78 [95% CI, 1.95–3.80], P<0.001) or EuroSCORE‐II (HR, 1.85 [95% CI, 1.35–2.56], P<0.001). Both AKI and CKD significantly and independently affected primary outcome (HR, 3.06 [95% CI, 2.01–4.64], P<0.001 and HR, 1.82 [95% CI 1.27–2.65], P<0.01, respectively). The estimated proportion of the total effect of CKD mediated via AKI was, on average, 15%, 95% CI, 4%–29%, P<0.001. The significant effect of Bleeding Academic Research Consortium 2–5 bleedings on the primary outcome was not mediated by AKI. Conclusions AKI occurs in 1 out of 6 patients and significantly mediates one fifth of the effect of baseline CKD on all‐cause mortality after TAVR. Our analysis supports a systematic effort to prevent AKI during TAVR, which may potentially translate into improved patients' 1‐year survival.

2 citations

Journal Article•DOI•
In-hospital outcomes following percutaneous versus surgical intervention in the treatment of aortic stenosis and concomitant coronary artery disease.

[...]

A Mcinerney, María García Márquez, Gabriela Tirado-Conte, José Luis Bernal, C. Fernández-Pérez, Pilar Jiménez-Quevedo, Nieves Gonzalo, Iván J. Núñez-Gil, Náyade del Prado, Javier Escaned, Antonio Fernández-Ortiz, J. Elola, Luis Nombela-Franco 
01 Jan 2023-Revista Espanola De Cardiologia
TL;DR: In this article , percutaneous management of aortic stenosis and coronary artery bypass grafting with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention.
Abstract: Concomitant coronary artery disease (CAD) is prevalent among aortic stenosis patients; however the optimal therapeutic strategy remains debated. We investigated periprocedural outcomes among patients undergoing transcatheter aortic valve implantation with percutaneous coronary intervention (TAVI/PCI) vs surgical aortic valve replacement with coronary artery bypass grafting (SAVR/CABG) for aortic stenosis with CAD. Using discharge data from the Spanish National Health System, we identified 6194 patients (5217 SAVR/CABG and 977 TAVI/PCI) between 2016 and 2019. Propensity score matching was adjusted for baseline characteristics. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were in-hospital complications and 30-day cardiovascular readmission. Matching resulted in 774 pairs. In-hospital all-cause mortality was more common in the SAVR/CABG group (3.4% vs 9.4%, P < .001) as was periprocedural stroke (0.9% vs 2.2%; P = .004), acute kidney injury (4.3% vs 16.0%, P < .001), blood transfusion (9.6% vs 21.1%, P < .001), and hospital-acquired pneumonia (0.1% vs 1.7%, P = .001). Permanent pacemaker implantation was higher for matched TAVI/PCI (12.0% vs 5.7%, P < .001). Lower volume centers (< 130 procedures/y) had higher in-hospital all-cause mortality for both procedures: TAVI/PCI (3.6% vs 2.9%, P < .001) and SAVR/CABG (8.3 vs 6.8%, P < .001). Thirty-day cardiovascular readmission did not differ between groups. In this large contemporary nationwide study, percutaneous management of aortic stenosis and CAD with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention. Higher volume centers had less in-hospital mortality in both groups. Dedicated national high-volume heart centers warrant further investigation. La enfermedad coronaria (EC) es frecuente en pacientes con estenosis aórtica; sin embargo, la estrategia terapéutica óptima sigue siendo objeto de debate. Investigamos los resultados periprocedimiento en pacientes sometidos a implante percutáneo de válvula aórtica con intervención coronaria percutánea (TAVI/ICP) frente al recambio valvular aórtico con injerto de derivación de arteria coronaria (RVAo/CABG) en pacientes con estenosis aórtica con EC. Con los datos de alta del Sistema Nacional de Salud Español, se identificaron 6.194 pacientes (5.217 RVAo/CABG y 977 TAVI/ICP) entre 2016 y 2019. Se realizó un análisis emparejado por puntuación de propensión ajustado por características basales. El objetivo primario fue la mortalidad hospitalaria, Los objetivos secundarios fueron las complicaciones hospitalarias y rehospitalización cardiovascular a 30 días. Tras el emparejamiento, se seleccionaron 774 parejas de pacientes. La mortalidad total hospitalaria fue más frecuente en el grupo quirúrgico (3,4 frente a 9,4%, p < 0,001), al igual que el ictus periprocedimiento (0,9 frente a 2,2%, p = 0,004), fallo renal agudo (4,3 frente a 16,0%, p < 0,002), transfusión (9,6 frente a 21,1%, p < 0,001) y neumonía intrahospitalaria (0,1 frente a 1,7%, p = 0,001). La implantación de marcapasos permanente fue más frecuente en el tratamiento percutáneo (12,0 frente a 5,7%, p < 0,001). Los centros de menor volumen (< 130 procedimientos por año) tuvieron mayor mortalidad hospitalaria para ambos procedimientos: TAVI/ICP (3,6 frente a 2,9%, p < 0,001) y RVAo/CABG (9,3 frente a 6,8%, p < 0,001). La rehospitalización cardiovascular a 30 días no difirió entre los grupos. En este estudio nacional contemporáneo, el tratamiento percutáneo de estenosis aórtica y EC tuvo menor mortalidad y morbilidad intrahospitalaria que la intervención quirúrgica. Los centros de mayor volumen presentaron menor mortalidad hospitalaria en ambos grupos, justificándose investigaciones futuras en centros nacionales de alto volumen.

1 citations

Journal Article•DOI•
Minimally invasive surgical aortic valve replacement versus transfemoral transcatheter aortic valve implantation in low-risk octogenarians : Observational, retrospective and single-center study.

[...]

Tadeja Kolar, Matjaz Bunc, Matija Jelenc, Simon Terseglav, A. Kotnik, Nikola Lakič 
14 Oct 2022-Wiener klinische Wochenschrift
TL;DR: The present study on low-risk octogenarians, transfemoral TAVI and minimally invasive AVR showed comparable short-term and mid-term results, and both procedures are deemed safe and effective.
References
More filters
Journal Article•DOI•
Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients

[...]

Jeffrey J. Popma1, G. Michael Deeb2, Steven J. Yakubov, Mubashir Mumtaz3, Hemal Gada3, Daniel O'Hair4, Tanvir Bajwa4, John Heiser5, William Merhi5, Neal S. Kleiman, Judah Askew, Paul Sorajja, Joshua Rovin, Stanley Chetcuti2, David H. Adams6, P.S. Teirstein7, George L. Zorn8, John K. Forrest9, Didier Tchetche, Jon R. Resar10, Antony Walton11, Nicolo Piazza12, Basel Ramlawi, Newell Robinson13, George Petrossian13, Thomas G. Gleason14, Jae K. Oh15, Michael J. Boulware16, Hongyan Qiao16, Andrew S. Mugglin17, Michael J. Reardon •
Harvard University1, University of Michigan2, PinnacleHealth System3, St. Luke's Hospital4, Spectrum Health5, Mount Sinai Hospital6, Scripps Research Institute7, University of Kansas8, Yale University9, Johns Hopkins University10, Alfred Hospital11, McGill University12, Saint Francis University13, University of Pittsburgh14, Mayo Clinic15, Medtronic plc16, Paradigm17
16 Mar 2019-The New England Journal of Medicine
TL;DR: In patients with severe aortic stenosis who were at low surgical risk, TAVR with a self‐expanding supraannular bioprosthesis was noninferior to surgery with respect to the composite end point of death or disabling stroke at 24 months.
Abstract: Background Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is know...

2,240 citations

Journal Article•DOI•
EuroSCORE II dagger

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Samer A.M. Nashef, François Roques, Linda D. Sharples, Johan Nilsson, Christopher Smith, Antony R Goldstone, Ulf Lockowandt 
01 Jan 2012-European Journal of Cardio-Thoracic Surgery
TL;DR: Cardiac surgical mortality has significantly reduced in the last 15 years despite older and sicker patients, and EuroSCORE II is better calibrated than the original model yet preserves powerful discrimination.
Abstract: To update the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk model. A dedicated website collected prospective risk and outcome data on 22 381 consecutive patients undergoing major cardiac surgery in 154 hospitals in 43 countries over a 12-week period (May-July 2010). Completeness and accuracy were validated during data collection using mandatory field entry, error and range checks and after data collection using summary feedback confirmation by responsible officers and multiple logic checks. Information was obtained on existing EuroSCORE risk factors and additional factors proven to influence risk from research conducted since the original model. The primary outcome was mortality at the base hospital. Secondary outcomes were mortality at 30 and 90 days. The data set was divided into a developmental subset for logistic regression modelling and a validation subset for model testing. A logistic risk model (EuroSCORE II) was then constructed and tested. Compared with the original 1995 EuroSCORE database (in brackets), the mean age was up at 64.7 (62.5) with 31% females (28%). More patients had New York Heart Association class IV, extracardiac arteriopathy, renal and pulmonary dysfunction. Overall mortality was 3.9% (4.6%). When applied to the current data, the old risk models overpredicted mortality (actual: 3.9%; additive predicted: 5.8%; logistic predicted: 7.57%). EuroSCORE II was well calibrated on testing in the validation data subset of 5553 patients (actual mortality: 4.18%; predicted: 3.95%). Very good discrimination was maintained with an area under the receiver operating characteristic curve of 0.8095. Cardiac surgical mortality has significantly reduced in the last 15 years despite older and sicker patients. EuroSCORE II is better calibrated than the original model yet preserves powerful discrimination. It is proposed for the future assessment of cardiac surgical risk. (Less)

1,985 citations

Journal Article•DOI•
Updated Standardized Endpoint Definitions for Transcatheter Aortic Valve Implantation

[...]

A. Pieter Kappetein, Stuart J. Head, Philippe Généreux, Nicolo Piazza, Nicolas M. Van Mieghem, Eugene H. Blackstone, Thomas G. Brott, David Cohen, Donald E. Cutlip, Gerrit-Anne van Es, Rebecca T. Hahn, Ajay J. Kirtane, Mitchell W. Krucoff, Susheel Kodali, Michael J. Mack, Roxana Mehran, Josep Rodés-Cabau, Pascal Vranckx, John G. Webb, Stephan Windecker, Patrick W. Serruys, Martin B. Leon 
01 Oct 2012-Journal of the American College of Cardiology
TL;DR: This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVi and/or surgical aortic valve replacement.

1,874 citations

Journal Article•DOI•
Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1).

[...]

John A. Kellum1, Norbert Lameire2•
University of Pittsburgh1, Ghent University Hospital2
04 Feb 2013-Critical Care
TL;DR: Key aspects of the guideline including definition and staging of AKI, as well as evaluation and nondialytic management are summarized, including treatment recommendations based on systematic reviews of relevant trials.
Abstract: Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many. In 2012, Kidney Disease: Improving Global Outcomes completed the first ever, international, multidisciplinary, clinical practice guideline for AKI. The guideline is based on evidence review and appraisal, and covers AKI definition, risk assessment, evaluation, prevention, and treatment. In this review we summarize key aspects of the guideline including definition and staging of AKI, as well as evaluation and nondialytic management. Contrast-induced AKI and management of renal replacement therapy will be addressed in a separate review. Treatment recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and a detailed rationale for each recommendation is provided.

1,602 citations

Journal Article•DOI•
Registry of Transcatheter Aortic-Valve Implantation in High-Risk Patients

[...]

M. Gilard, H. Eltchaninoff, Bernard Lung
02 May 2012-The New England Journal of Medicine
TL;DR: This prospective registry study reflected real-life TAVI experience in high-risk elderly patients with aortic stenosis, in whom T AVI appeared to be a reasonable option.
Abstract: BACKGROUND: Transcatheter aortic-valve implantation (TAVI) is an emerging intervention for the treatment of high-risk patients with severe aortic stenosis and coexisting illnesses. We report the results of a prospective multicenter study of the French national transcatheter aortic-valve implantation registry, FRANCE 2. METHODS: All TAVIs performed in France, as listed in the FRANCE 2 registry, were prospectively included in the study. The primary end point was death from any cause. RESULTS: A total of 3195 patients were enrolled between January 2010 and October 2011 at 34 centers. The mean (±SD) age was 82.7±7.2 years; 49% of the patients were women. All patients were highly symptomatic and were at high surgical risk for aortic-valve replacement. Edwards SAPIEN and Medtronic CoreValve devices were implanted in 66.9% and 33.1% of patients, respectively. Approaches were either transarterial (transfemoral, 74.6%; subclavian, 5.8%; and other, 1.8%) or transapical (17.8%). The procedural success rate was 96.9%. Rates of death at 30 days and 1 year were 9.7% and 24.0%, respectively. At 1 year, the incidence of stroke was 4.1%, and the incidence of periprosthetic aortic regurgitation was 64.5%. In a multivariate model, a higher logistic risk score on the European System for Cardiac Operative Risk Evaluation (EuroSCORE), New York Heart Association functional class III or IV symptoms, the use of a transapical TAVI approach, and a higher amount of periprosthetic regurgitation were significantly associated with reduced survival. CONCLUSIONS: This prospective registry study reflected real-life TAVI experience in high-risk elderly patients with aortic stenosis, in whom TAVI appeared to be a reasonable option. (Funded by Edwards Lifesciences and Medtronic.).

1,146 citations

Frequently Asked Questions (6)
Q1. What are the contributions mentioned in the paper "Acute kidney injury following aortic valve replacement in patients without chronic kidney disease moriyama, noriaki" ?

Moriyama et al. this paper investigated the incidence and predictors of acute kidney injury following aortic valve replacement in patients without chronic kidney disease. 

Ourfindings demonstrated that patients who underwent TAVR had a significantly lower incidence of AKIin comparison to those who underwent SAVR, and TAVR was associated with decreasing incidence ofAKI during study periods. 

AKI significantly increased the risk of 5-year mortality aftereither TAVR or SAVR and increasing severity of AKI was incrementally associated with 5-yearmortality. 

Patients withAKI had significantly increased 5-year mortality compared to those without AKI (unmatched 36.0%vs 19.1%, log-rank P<0.001; matched 36.3% vs 24.0%, log-rank P<0.001). 

Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT03385915.(URL https://clinicaltrials.gov/ct2/show/NCT03385915)4From the nationwide registry, 4555 consecutive patients with pre-procedural normal kidneyfunction who underwent TAVR and SAVR (TAVR, n=1215 and SAVR, n=3340) were evaluated. 

The adjusted hazard ratiosfor 5-year mortality were 1.58 (95%CI 1.20-2.08) for AKI grade 1, 3.27 (95%CI 2.09-5.06) for grade 2and 4.82 (95%CI 2.93-8.04) for grade 3.3Conclusions: TAVR in patients without CKD was associated with significantly less frequentincidence of AKI compared with SAVR. 

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What is the relationship between transcatheter aortic valve replacement (TAVR) and chronic Kidney disease?

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