1
|
Makki K, Ammar FI, Fernandez JA, AlGhamdi MA, Alturkistani AM, Hubayni RA, Khahwry EI. Incidence of Acute Kidney Injury Post Transcatheter Aortic Valve Implantation (TAVI): A Single-Center Experience. Cureus 2024; 16:e65187. [PMID: 39176328 PMCID: PMC11340251 DOI: 10.7759/cureus.65187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) has dramatically changed the approach to treating aortic stenosis, particularly for patients unsuitable for surgical aortic valve replacement. Nevertheless, the possibility of quick deterioration of kidney function, known as acute kidney injury (AKI), post operation is considered one of the complications. OBJECTIVES The study aimed to determine the incidence of AKI in adults post TAVI. METHODS This retrospective cohort study focuses on patients who underwent the TAVI procedure at the King Faisal Cardiac Center at the Ministry of National Guard Health Affairs (MNGHA) in Jeddah, Saudi Arabia, from May 2016 to December 2022. Acute kidney injury post TAVI was defined based on RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. Chi-square tests and independent sample t-tests were used to compare clinical and demographic characteristics between patients who developed AKI with those who did not, using an alpha of 5%. RESULTS The study involved 103 adult patients. Among them, 11 (10.7%) developed AKI post TAVI within seven days of the procedure, while 92 (89.3%) did not. Findings also revealed that patients with hyperlipidemia and a previous history of kidney diseases faced a higher risk of AKI post TAVI. Despite its valuable insights, the study has limitations due to its retrospective nature and small sample size. CONCLUSIONS The study emphasizes the importance of identifying patients with hyperlipidemia and pre-existing kidney conditions and closely monitoring renal function. While some preventive methods did not significantly impact AKI occurrences, further research is needed to refine preventive strategies.
Collapse
Affiliation(s)
- Khalid Makki
- Department of Anesthesiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Fatemah I Ammar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Jose Andres Fernandez
- Department of Anesthesiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Muhnnad A AlGhamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Rahaf A Hubayni
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Elaf I Khahwry
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| |
Collapse
|
2
|
Jalali Y, Jalali M, Števlík J. Perioperative Management of Valvular Heart Disease in Patients Undergoing Non-Cardiac Surgery. J Clin Med 2024; 13:3240. [PMID: 38892948 PMCID: PMC11173198 DOI: 10.3390/jcm13113240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/10/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Postoperative cardiovascular complications (either in a hospital or within 30 days after the operation) are among the most common problems with non-cardiac surgeries (NCSs). Pre-existing cardiac comorbidities add significant risk to the development of such complications. Valvular heart disease (VHD), a rather frequent cardiac comorbidity (especially in the elderly population), can pose serious life-threatening peri-/postoperative complications. Being familiar with the recommended perioperative management of patients with VHD or an implanted prosthetic heart valve who are scheduled for NCS is of great importance in daily clinical practice. Although recently published guidelines by the European Society of Cardiology (ESC) and the American College of Cardiology and American Heart Association (ACC/AHA) for the management of VHD and perioperative management of patients undergoing NCS addresses the mentioned problem, a comprehensive review of the guidelines that provides an easy-to-use summary of the recommendations and their similarities and differences is missing in the published literature. In this review article, we summarize all of the relevant important information based on the latest data published in both guidelines needed for practical decision-making in the perioperative management of patients with VHD or after valvular repair (with prosthetic heart valve) who are scheduled for NCS.
Collapse
Affiliation(s)
- Yashar Jalali
- Faculty of Medicine, Comenius University in Bratislava, 5th Department of Internal Medicine, University Hospital Bratislava, Ružinov, Špitálska 24, 813 72 Bratislava, Slovakia, and Ružinovská 4810/6, 821 01 Bratislava, Slovakia; (M.J.); (J.Š.)
| | | | | |
Collapse
|
3
|
Sigala E, Terentes-Printzios D, Gardikioti V, Baikoussis NG, Koumallos N, Katsaros A, Lozos V, Kouerinis I, Triantafillou K, Filis K, Tsioufis K, Vlachopoulos C. The Effect of Surgical Aortic Valve Replacement on Arterial Stiffness: Does the Valve Type Matter? J Pers Med 2024; 14:509. [PMID: 38793090 PMCID: PMC11122145 DOI: 10.3390/jpm14050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Despite the increasing use of transcatheter aortic valve procedures, many patients still require surgical aortic valve replacement (SAVR). Assessing arterial properties in patients undergoing SAVR for aortic valve stenosis can be challenging, and the existing evidence is inconclusive. Our study aimed to investigate the impact of SAVR on vascular stiffness and the quality of life, as well as the different effects of valve type on arterial properties. Methods: We included 60 patients (mean age 70.25 ± 8.76 years, 65% men) with severe symptomatic aortic stenosis who underwent SAVR. Arterial stiffness (cfPWV, baPWV) and vascular parameters (AIx@75, central pressures, SEVR) were measured at baseline, pre-discharge, and 1-year post-operation. The QOL was assessed using the generic questionnaire-short-form health survey 36 (SF-36) pre-operatively and at 1 year. Results: Post-SAVR, cfPWV increased immediately (7.67 ± 1.70 m/s vs. 8.27 ± 1.92 m/s, p = 0.009) and persisted at 1 year (8.27 ± 1.92 m/s vs. 9.29 ± 2.59 m/s, p ≤ 0.001). Similarly, baPWV (n = 55) increased acutely (1633 ± 429 cm/s vs. 2014 ± 606 cm/s, p < 0.001) and remained elevated at 1 year (1633 ± 429 cm/s vs. 1867 ± 408 cm/s, p < 0.001). Acute decrease in Alx@75 (31.16 ± 10% vs. 22.48 ± 13%, p < 0.001) reversed at 1 year (31.16 ± 10% vs. 30.98 ± 9%, p = 0.71). SEVR improved (136.1 ± 30.4% vs. 149.2 ± 32.7%, p = 0.01) and persisted at 1 year (136.1 ± 30.4% vs. 147.5 ± 30.4%, p = 0.01). SV had a greater cfPWV increase at 1 year (p = 0.049). The QOL improved irrespective of arterial stiffness changes. Conclusions: After SAVR, arterial stiffness demonstrates a persistent increase at 1-year, with valve type having a slight influence on the outcomes. These findings remain consistent despite the perceived QOL.
Collapse
Affiliation(s)
- Evangelia Sigala
- First Department of Cardiology, Hippokration Hospital, 11527 Athens, Greece
| | | | | | | | - Nikolaos Koumallos
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | - Andreas Katsaros
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | - Vasileios Lozos
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | - Ilias Kouerinis
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | | | - Konstantinos Filis
- First Department of Surgery, Hippokration Hospital, 11527 Athens, Greece;
| | | | | |
Collapse
|
4
|
Butala AD, Nanayakkara S, Navani RV, Palmer S, Noaman S, Haji K, Htun NM, Walton AS, Stub D. Acute Kidney Injury Following Transcatheter Aortic Valve Implantation-A Contemporary Perspective of Incidence, Predictors, and Outcomes. Heart Lung Circ 2024; 33:316-323. [PMID: 38245395 DOI: 10.1016/j.hlc.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/08/2023] [Accepted: 11/08/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a known complication following transcatheter aortic valve implantation (TAVI), associated with increased morbidity and mortality. Most of this data relates to higher-risk patients with early-generation TAVI valves. With TAVI now established as a safe and cost-effective procedure for low-risk patients, there is a distinct need for updated analysis. We aimed to assess the incidence, predictors, and outcomes of AKI in a contemporary cohort of TAVI patients, concurrently examining the role of temporal evolution on AKI. METHOD A total of 2,564 patients undergoing TAVI from 2008-2023 included in the Alfred-Cabrini-Epworth (ACE) TAVI Registry were analysed. Patients were divided into AKI and no AKI groups. Outcomes were reported according to the Valve Academic Research Consortium-3 (VARC-3) criteria. RESULTS Of 2,564 patients, median age 83 (78-87) years, 57.4% men and a median Society of Thoracic Surgeons score of 3.6 (2.4-5.5), 163 (6.4%) patients developed AKI with incidence falling from 9.7% between 2008-2014 to 6% between 2015-2023 (p=0.022). On multivariable analysis, independent predictors of AKI were male sex (adjusted odds ratio [aOR] 1.89, p=0.005), congestive cardiac failure (aOR 1.52, p=0.048), estimated glomerular filtration rate 30-59 (aOR: 2.79, p<0.001), estimated glomerular filtration rate <30 (aOR 8.65, p<0.001), non-femoral access (aOR 5.35, p<0.001), contrast volume (aOR 1.01, p<0.001), self-expanding valve (aOR 1.60, p=0.045), and bleeding (aOR 2.88, p=0.005). Acute kidney injury was an independent predictor of 30-day (aOR: 6.07, p<0.001) and 12-month (aOR: 3.01, p=0.002) mortality, an association that remained consistent when excluding TAVIs performed prior to 2015. CONCLUSIONS Acute kidney injury remains a relatively common complication of TAVI, associated with significant morbidity and mortality even in less comorbid, contemporary practice patients.
Collapse
Affiliation(s)
- Anant D Butala
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia. https://twitter.com/anant_butala
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia. https://twitter.com/DrNanayakkara
| | - Rohan V Navani
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Sonny Palmer
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia. https://twitter.com/SamerNoaman
| | - Kawa Haji
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Nay M Htun
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia
| | - Antony S Walton
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic, Australia.
| |
Collapse
|
5
|
Wu X, Yan P, Duan SB, Luo XQ, Zhang NY, Deng YH. Temporal trends of post-contrast acute kidney injury in patients with intravenous administration of iodinated contrast medium. Ren Fail 2023; 45:2251588. [PMID: 37724551 PMCID: PMC10512889 DOI: 10.1080/0886022x.2023.2251588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/20/2023] [Indexed: 09/21/2023] Open
Abstract
Little is known about whether preventative practices for post-contrast acute kidney injury (PC-AKI) recommended in guidelines have been adopted in clinical practice and translated into a lower incidence of PC-AKI. The aim of this study was to examine the yearly trends in the incidence of PC-AKI, and comorbidities and care practices associated with PC-AKI in hospitalized patients who received intravenous administration of iodinated contrast medium (ICM). Adult patients receiving intravenous ICM at the Second Xiangya Hospital of Central South University in China between 2015 and 2021 were included. Temporal trends in the incidence and risk factors for PC-AKI were evaluated using logistic regression analyses with adjustments for relevant variables. The incidence of PC-AKI has declined significantly from 5.3% in 2015 to 4.1% in 2021 (p < 0.001). This decreasing trend persisted after extensive multivariable adjustments. Of the comorbidities associated with PC-AKI, the proportion of patients with congestive heart failure or hypertension increased, while the proportion of patients older than 75 years, or with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2, diabetic nephropathy, or renal stone disease decreased. Among the care practices associated with PC-AKI, the proportion of patients using nephrotoxic drugs decreased, whereas the proportion of patients receiving intravenous fluids > 1000 mL on the day of ICM administration or using iso-osmolar ICM increased. In conclusion, a declining trend in PC-AKI incidence was observed in patients receiving intravenous ICM between 2015 and 2021, which may be related to increased awareness and efforts to prevent PC-AKI.
Collapse
Affiliation(s)
- Xi Wu
- Department of Nephrology, The Second Xiangya Hospital of Central South University; Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, P.R. China
| | - Ping Yan
- Department of Nephrology, The Second Xiangya Hospital of Central South University; Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, P.R. China
| | - Shao-Bin Duan
- Department of Nephrology, The Second Xiangya Hospital of Central South University; Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, P.R. China
| | - Xiao-Qin Luo
- Department of Nephrology, The Second Xiangya Hospital of Central South University; Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, P.R. China
| | - Ning-Ya Zhang
- Information Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Ying-Hao Deng
- Department of Nephrology, The Second Xiangya Hospital of Central South University; Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, P.R. China
| |
Collapse
|
6
|
Arrotti S, Sgura FA, Monopoli DE, Siena V, Leo G, Morgante V, Cataldo P, Magnavacchi P, Gabbieri D, Guiducci V, Benatti G, Vignali L, Boriani G, Rossi R. The Importance of Mehran Score to Predict Acute Kidney Injury in Patients with TAVI: A Large Multicenter Cohort Study. J Cardiovasc Dev Dis 2023; 10:228. [PMID: 37367393 DOI: 10.3390/jcdd10060228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has developed as an alternative to surgery for symptomatic high-risk patients with aortic stenosis (AS). An important complication of TAVI is acute kidney injury. The purpose of the study was to investigate if the Mehran Score (MS) could be used to predict acute kidney injury (AKI) in TAVI patients. METHODS This is a multicenter, retrospective, observational study including 1180 patients with severe AS. The MS comprised eight clinical and procedural variables: hypotension, congestive heart failure class, glomerular filtration rate, diabetes, age >75 years, anemia, need for intra-aortic balloon pump, and contrast agent volume use. We assessed the sensitivity and specificity of the MS in predicting AKI following TAVI, as well as the predictive value of MS with each AKI-related characteristic. RESULTS Patients were categorized into four risk groups based on MS: low (≤5), moderate (6-10), high (11-15), and very high (≥16). Post-procedural AKI was observed in 139 patients (11.8%). MS classes had a higher risk of AKI in the multivariate analysis (HR 1.38, 95% CI, 1.43-1.63, p < 0.01). The best cutoff for MS to predict the onset of AKI was 13.0 (AUC, 0.62; 95% CI, 0.57-0.67), whereas the best cutoff for eGFR was 42.0 mL/min/1.73 m2 (AUC, 0.61; 95% CI, 0.56-0.67). CONCLUSIONS MS was shown to be a predictor of AKI development in TAVI patients.
Collapse
Affiliation(s)
- Salvatore Arrotti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Fabio Alfredo Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Daniel Enrique Monopoli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Valerio Siena
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Giulio Leo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Vernizia Morgante
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Paolo Cataldo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | | | - Davide Gabbieri
- Cardiac Surgery Division, Hesperia Hospital, 41125 Modena, Italy
| | - Vincenzo Guiducci
- Division of Cardiology, AUSL-IRCCS Reggio Emilia, 42121 Reggio Emilia, Italy
| | - Giorgio Benatti
- Cardiology Division, Parma University Hospital, 44129 Parma, Italy
| | - Luigi Vignali
- Cardiology Division, Parma University Hospital, 44129 Parma, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Rosario Rossi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| |
Collapse
|