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Delirium After TAVR. JACC Cardiovasc Interv 2020; 13:2453-2466. [DOI: 10.1016/j.jcin.2020.07.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/02/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022]
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2
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Cherry AD, Hauck JN, Andrew BY, Li YJ, Privratsky JR, Kartha LD, Nicoara A, Thompson A, Mathew JP, Stafford-Smith M. Intraoperative renal resistive index threshold as an acute kidney injury biomarker. J Clin Anesth 2019; 61:109626. [PMID: 31699495 DOI: 10.1016/j.jclinane.2019.109626] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVE The lag in creatinine-mediated diagnosis of cardiac surgery-associated acute kidney injury (AKI) may be impeding the development of renoprotection therapies. Postoperative renal resistive index (RRI) measured by transabdominal Doppler ultrasound is a promising early AKI biomarker. RRI measured intraoperatively by transesophageal echocardiography (TEE) is available even earlier but is less evaluated. Therefore, we conducted an assessment of intraoperative RRI as an AKI biomarker using previously reported post-renal insult thresholds. DESIGN Retrospective convenience sample. SETTING Intraoperative. PATIENTS 180 adult cardiac surgical patients between July 2013 and July 2014. INTERVENTION None. MEASUREMENTS Pre- and post-cardiopulmonary bypass (CPB) RRI thresholds, measured using intraoperative TEE, exceeding 0.74 or 0.79 were used to evaluate for an association with KDIGO AKI risk using the Chi-square test. Other consensus AKI criteria (AKIN, RIFLE) were similarly evaluated. Additional t-test analyses examined the relationship of pre- and pre-to-post (delta) CPB RRI with AKI. MAIN RESULTS Post-CPB RRI for 99 patients included 36 and 23 with values exceeding 0.74 and 0.79, respectively. Analyses confirmed associations of both RRI thresholds with all consensus AKI definitions (0.74; KDIGO: p = 0.05, AKIN: p = 0.03, RIFLE: p = 0.03, 0.79; KDIGO: p = 0.002, AKIN: p = 0.001, RIFLE: p = 0.004). In contrast, pre-CPB and pre-to post-CPB RRI were not associated with AKI. CONCLUSIONS RRI obtained intraoperatively in cardiac surgery patients, assessed using previously reported thresholds, is highly associated with AKI and warrants further evaluation as a promising "earliest" AKI biomarker. These significant findings suggest that RRI assessment should be included in the standard intraoperative TEE exam.
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Affiliation(s)
- Anne D Cherry
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Jennifer N Hauck
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Benjamin Y Andrew
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Yi-Ju Li
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Jamie R Privratsky
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Lakshmi D Kartha
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA; MetroHealth Hospital, Dept. of Internal Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Alina Nicoara
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Annemarie Thompson
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Joseph P Mathew
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Mark Stafford-Smith
- Duke University Medical Center, Department of Anesthesiology, 2301 Erwin Road, Durham, NC 27710, USA.
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3
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Zaleska-Kociecka M, Dabrowski M, Stepinska J. Acute kidney injury after transcatheter aortic valve replacement in the elderly: outcomes and risk management. Clin Interv Aging 2019; 14:195-201. [PMID: 30718946 PMCID: PMC6345183 DOI: 10.2147/cia.s149916] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aortic stenosis is the most common cause of valve replacement in Europe and North America with prevalence increasing with age. Transcatheter valve replacement (TAVR) represents an alternative for surgical valve replacement of severely stenotic valves. Despite lower risk of acute kidney injury compared to that associated with surgery, this complication remains prevalent in patients undergoing TAVR. There is a paucity of data confirming the relation of acute kidney injury with high morbidity and mortality, especially when superimposed on chronic kidney disease, which is a frequent comorbidity in the elderly with severe aortic stenosis. As there is no consensus on the prevention of acute kidney injury in patients undergoing TAVR, identification and limitation of risk factors are crucial. In this review, we aim to discuss the key aspects of acute kidney injury diagnosis, risk assessment, and outcomes in TAVR patients, and to point out gaps in current knowledge.
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Affiliation(s)
| | - Maciej Dabrowski
- Interventional Cardiology and Angiology Clinic, Institute of Cardiology, Warsaw, Poland
| | - Janina Stepinska
- Cardiac Intensive Therapy Clinic, Institute of Cardiology, Warsaw, Poland,
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4
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Vo TX, Boodhwani M. Renal resistive index as a biomarker for acute kidney injury in aortic valve surgery. J Thorac Dis 2019; 10:S4010-S4012. [PMID: 30631541 DOI: 10.21037/jtd.2018.09.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Thin Xuan Vo
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
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5
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Ma M, Gao WD, Gu YF, Wang YS, Zhu Y, He Y. Clinical effects of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis. Intern Emerg Med 2019; 14:161-175. [PMID: 30173298 DOI: 10.1007/s11739-018-1935-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022]
Abstract
Several observational studies have shown that postoperative acute kidney injury (AKI) may significantly worsen the prognosis of a transcatheter aortic valve implantation (TAVI). The purpose of this systematic review and meta-analysis is to evaluate the recent evidence on the impact of AKI on clinical outcomes following TAVI. A comprehensive search in PubMed, Embase and the Cochrane Library was performed for relevant studies by two independent investigators. We pooled the odds ratio (OR) from individual studies, and performed heterogeneity, quality assessment and publication bias analysis. Forty-three eligible studies comprising 544,112 patients were included. Postoperative AKI not only significantly increased the risk for short-term and long-term all-cause mortality (OR 6.25, 95% CI 5.72-6.83, P < 0.00001; OR 3.49, 95% CI 2.78-4.40, P < 0.00001, respectively), but also increased the risk for early myocardial infarction (OR 3.98, 95% CI 1.90-8.31, P = 0.0002), major and life-threatening bleeding (OR 1.51, 95% CI 1.12-2.03, P = 0.007; OR 2.35, 95% CI 1.80-3.06, P < 0.00001, respectively), major vascular complications (OR 1.69, 95% CI 1.30-2.18, P < 0.0001), need for blood transfusion (OR 2.15, 95% CI 1.89-2.46, P < 0.00001) renal replacement therapy (OR 22.36, 95% CI 11.88-42.12, P = 0.0002) and cerebrovascular accidents (OR 1.92, 95% CI 1.23-2.98, P = 0.004). Acute kidney injury following TAVI is associated with increased postoperative mortality and morbidity. Future efforts are required to determine whether early prevention of post-procedural AKI after TAVI impacts upon clinical outcomes.
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Affiliation(s)
- Min Ma
- Department of Cardiology, The Sixth People's Hospital of Chengdu, Chengdu, 610051, China
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Street, Chengdu, 610041, China
| | - Wei-Dong Gao
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, 529030, Guangduo, China
| | - Yun-Fei Gu
- Department of Cardiology, LuoYang Central Hospital Affiliated to ZhengZhou University, No 288 Zhongzhou Road, Luoyang, 471000, China
| | - Yu-Shu Wang
- Department of Cardiology, The First People's Hospital of Chengdu, Chengdu, 610016, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Street, Chengdu, 610041, China
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Street, Chengdu, 610041, China.
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6
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Andrew BY, Cherry AD, Hauck JN, Nicoara A, Maxwell CD, Konoske RM, Thompson A, Kartha LD, Swaminathan M, Stafford-Smith M. The Association of Aortic Valve Pathology With Renal Resistive Index as a Kidney Injury Biomarker. Ann Thorac Surg 2018; 106:107-114. [PMID: 29427619 DOI: 10.1016/j.athoracsur.2018.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/14/2017] [Accepted: 01/03/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common serious complication after cardiac surgery. Doppler-determined renal resistive index (RRI) is a promising early AKI biomarker in this population. However, the relationship between aortic valve pathology (insufficiency and/or stenosis) and RRI is unknown. This study aimed to investigate RRI variability related to aortic valve pathology. METHODS In a retrospective review of cardiac surgery patients, RRI and aortic valve pathology were assessed prior to cardiopulmonary bypass using transesophageal echocardiography. Aortic valve status was categorized into four subgroups: normal (insufficiency and stenosis, none/trace/mild), insufficiency (insufficiency, moderate/severe; stenosis, none/trace/mild), combined insufficiency/stenosis (insufficiency and stenosis, moderate/severe), or stenosis (insufficiency, none/trace/mild; stenosis, moderate/severe). RRI and time-matched hemodynamic and Doppler measurements were compared among subgroups. RESULTS Of 175 patients, 60 had aortic valve pathology (16 insufficiency, 18 insufficiency/stenosis, 26 stenosis). Compared with the normal subgroup, patients with aortic insufficiency had lower diastolic blood pressure and trough renal Doppler velocities, and higher RRI (0.77 versus 0.69; p < 0.001); patients with combined insufficiency/stenosis also had higher RRI (0.72 versus 0.69, p = 0.042). CONCLUSIONS Patients with aortic insufficiency and combined insufficiency/stenosis had higher median RRI values compared with normal patients. For these individuals, diastolic flow differences related to aortic insufficiency may explain why their presurgery RRI values often exceeded postoperative thresholds typically associated with AKI. Strategies to account for the potentially confounding effects of aortic insufficiency on renal flow patterns, independent of renal injury, may add to the value of RRI as an early AKI biomarker.
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Affiliation(s)
- Benjamin Y Andrew
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; Clinical Research Training Program, Duke University School of Medicine, Durham, North Carolina
| | - Anne D Cherry
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Jennifer N Hauck
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Cory D Maxwell
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Ryan M Konoske
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Annemarie Thompson
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Lakshmi D Kartha
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Mark Stafford-Smith
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
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Zaouter C, Priem F, Leroux L, Bonnet G, Bats ML, Beauvieux MC, Rémy A, Ouattara A. New markers for early detection of acute kidney injury after transcatheter aortic valve implantation. Anaesth Crit Care Pain Med 2017; 37:319-326. [PMID: 29146295 DOI: 10.1016/j.accpm.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/13/2017] [Accepted: 10/15/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent complication after a transcatheter aortic valve implantation (TAVI). Biomarkers such as urinary G1 cell cycle arrest proteins (TIMP-2 and IGFBP7) and sonographic evaluation (Doppler Renal Resistive Index [RRI]) have been advocated to predict AKI at an early stage after a TAVI-procedure. The primary aim was to determine the predictive value of these markers to detect AKI after a TAVI-procedure at an early phase. PATIENTS AND METHODS In a prospective observational study, 62 consecutive patients were scheduled for a TAVI. AKI was assessed based on the KDIGO criteria. Biomarkers and RRI were measured concomitantly before TAVI, at the first micturition post-implantation and the first micturition on the morning after the procedure. RESULTS Twenty-two patients (35%) developed AKI. On the first day after the TAVI-procedure, urinary TIMP-2 and IGFBP7 concentrations increased significantly in patients who developed AKI (0.1, [interquartile] [0.1-0.35] to 0.40 [0.10-1.00] vs. 0.2 [0.1-0.5] to 0.10 [0.10-0.20], P=0.012) with an area under the receiver-operating characteristic curve of 0.71 [0.55-0.83]. Sensitivity was 0.57 and specificity was 0.83 for a cut-off value of 0.35. No significant increases in RRI were found in patients who developed AKI. CONCLUSIONS Based on the current guidelines for the diagnosis of AKI, the urinary proteins TIMP-2 and IGFBP7 do not detect AKI at an early stage accurately in patients undergoing a TAVI-procedure.
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Affiliation(s)
- Cédrick Zaouter
- Department of Anaesthesia and Critical Care II, Magellan Medico-Surgical Center, CHU of Bordeaux, 33000 Bordeaux, France.
| | - Frédérique Priem
- Department of Anaesthesia and Critical Care II, Magellan Medico-Surgical Center, CHU of Bordeaux, 33000 Bordeaux, France
| | - Lionel Leroux
- Department of Cardiology, CHU of Bordeaux, 33000 Bordeaux, France
| | - Guillaume Bonnet
- Department of Cardiology, CHU of Bordeaux, 33000 Bordeaux, France
| | - Marie-Lise Bats
- Department of Biochemistry, CHU of Bordeaux, 33000 Bordeaux, France
| | | | - Alain Rémy
- Department of Anaesthesia and Critical Care II, Magellan Medico-Surgical Center, CHU of Bordeaux, 33000 Bordeaux, France
| | - Alexandre Ouattara
- Department of Anaesthesia and Critical Care II, Magellan Medico-Surgical Center, CHU of Bordeaux, 33000 Bordeaux, France; Inserm, UMR 1034, Biology of Cardiovascular Diseases, University of Bordeaux, 33600 Pessac, France
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8
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Liao YB, Deng XX, Meng Y, Zhao ZG, Xiong TY, Meng XJ, Zuo ZL, Li YJ, Cao JY, Xu YN, Chen M, Feng Y. Predictors and outcome of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis. EUROINTERVENTION 2017; 12:2067-2074. [DOI: 10.4244/eij-d-15-00254] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Wang J, Yu W, Zhou Y, Yang Y, Li C, Liu N, Hou X, Wang L. Independent Risk Factors Contributing to Acute Kidney Injury According to Updated Valve Academic Research Consortium-2 Criteria After Transcatheter Aortic Valve Implantation: A Meta-analysis and Meta-regression of 13 Studies. J Cardiothorac Vasc Anesth 2016; 31:816-826. [PMID: 28385646 DOI: 10.1053/j.jvca.2016.12.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to examine the risk factors for transcatheter aortic valve implantation (TAVI)-associated acute kidney injury (AKI) according to the AKI definition from the Valve Academic Research Consortium-2 (VARC-2). SETTING A meta-analysis. PARTICIPANTS A total of 661 patients with post-TAVI AKI according to the VARC-2 definition and 2,012 controls were included in the meta-analysis. INTERVENTIONS Patients undergoing TAVI were included in this meta-analysis. MEASUREMENTS AND MAIN RESULTS Multiple electronic databases were searched using predefined criteria. The diagnosis of AKI was based on the VARC-2 classification. The authors found that preoperative New York Heart Association class IV (odds ratio [OR], 7.77; 95% confidence interval [CI], 3.81-15.85), previous chronic renal disease (CKD) (OR, 2.81; 95% CI, 1.96-4.03), and requirement for transfusion (OR, 2.03; 95% CI, 1.59-2.59) were associated significantly with an increased risk for post-TAVI AKI. Furthermore, previous peripheral vascular disease (PVD), hypertension, atrial fibrillation, congestive heart failure, diabetes mellitus, and stroke were also risk factors for TAVI-associated AKI. Additionally, transfemoral access significantly correlated with a reduced risk for post-TAVI AKI (OR, 0.43; 95% CI, 0.33-0.57). The potential confounders, including Society of Thoracic Surgeons Score, the logistic European System for Cardiac Operative Risk Evaluation, aortic valve area, mean pressure gradient, left ventricular ejection fraction, age, body mass index, contrast volume, and valve type, had no impact on the association between the risk factors and post-TAVI AKI. Subgroup analysis of the eligible studies presenting multivariate logistic regression analysis on the independent risk factors for post-TAVI AKI revealed that previous CKD, previous PVD, and transapical access were independent risk factors for TAVI-associated AKI. CONCLUSIONS The current meta-analysis suggested that previous CKD, previous PVD, and transapical access may be independent risk factors for TAVI-associated AKI.
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Affiliation(s)
- Jiayang Wang
- Department of Cardiac Surgery, Beijing An Zhen Hospital Capital Medical University, Beijing, China; Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Ye Zhou
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Yong Yang
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Chenglong Li
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Nan Liu
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China.
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Longfei Wang
- Department of Cardiac Surgery, Beijing An Zhen Hospital Capital Medical University, Beijing, China
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Neunhoeffer F, Wiest M, Sandner K, Renk H, Heimberg E, Haller C, Kumpf M, Schlensak C, Hofbeck M. Non-invasive measurement of renal perfusion and oxygen metabolism to predict postoperative acute kidney injury in neonates and infants after cardiopulmonary bypass surgery. Br J Anaesth 2016; 117:623-634. [DOI: 10.1093/bja/aew307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 02/06/2023] Open
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Cheungpasitporn W, Thongprayoon C, Kashani K. Transcatheter Aortic Valve Replacement: a Kidney's Perspective. J Renal Inj Prev 2016; 5:1-7. [PMID: 27069960 PMCID: PMC4827378 DOI: 10.15171/jrip.2016.01] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/05/2016] [Indexed: 12/24/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has now emerged as a viable treatment option for high-risk patients with severe aortic stenosis (AS) who are not suitable candidates for surgical aortic valve replacement (SAVR). Despite encouraging published outcomes, acute kidney injury (AKI) is common and lowers the survival of patients after TAVR. The pathogenesis of AKI after TAVR is multifactorial including TAVR specific factors such as the use of contrast agents, hypotension during rapid pacing, and embolization; preventive measures may include pre-procedural hydration, limitation of contrast dye exposure, and avoidance of intraprocedural hypotension. In recent years, the number of TAVR performed worldwide has been increasing, as well as published data on renal perspectives of TAVR including AKI, chronic kidney disease, end-stage kidney disease, and kidney transplantation. This review aims to present the current literature on the nephrology aspects of TAVR, ultimately to improve the patients' quality of care and outcomes.
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Affiliation(s)
- Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Abstract
Even though experience and techniques have constantly improved over the last years, peri- and postprocedural complications in high risk TAVI-collectives remain a major issue affecting outcome and survival. Acute kidney injury (AKI) is a frequent complication after transcatheter aortic valve implantation (TAVI) and effects outcome and survival. However, the definition of AKI in published studies dealing with the phenomenon of AKI after TAVI varies widely and lacks standardization. This Review aims to present an overview over the current literature concerning AKI after TAVI with regard to the definition of AKI, the impact of AKI on mortality and potential risk factors for renal impairment after TAVI.
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Affiliation(s)
- Maximilian Scherner
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
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13
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O'Sullivan CJ, Wenaweser P. Optimizing clinical outcomes of transcatheter aortic valve implantation patients with comorbidities. Expert Rev Cardiovasc Ther 2015; 13:1419-32. [PMID: 26479904 DOI: 10.1586/14779072.2015.1102056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of high-risk or inoperable patients presenting with symptomatic severe aortic stenosis (AS). There are several factors to consider to optimize patient outcomes from TAVI. Before TAVI, patient selection is key and an understanding the effects of common comorbidities on outcomes after TAVI is critical. Some comorbidities share common risk factors with AS (e.g. coronary artery disease), others are directly or indirectly caused or exacerbated by severe AS (e.g. atrial fibrillation, pulmonary hypertension, mitral regurgitation, tricuspid regurgitation and right ventricular dysfunction), whereas others are not directly related to severe AS (e.g. chronic kidney disease and chronic lung disease). Choice of transcatheter heart valve prosthesis, vascular access route and mode of anesthesia are important considerations during TAVI. New onset conduction disturbances and arrhythmias remain a vexing issue after TAVI. The aim of the present review is to provide an overview of these issues.
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Affiliation(s)
| | - Peter Wenaweser
- b Department of Cardiology , Bern University Hospital , Bern , Switzerland
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14
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Gargiulo G, Sannino A, Capodanno D, Perrino C, Capranzano P, Barbanti M, Stabile E, Trimarco B, Tamburino C, Esposito G. Impact of postoperative acute kidney injury on clinical outcomes after transcatheter aortic valve implantation: A meta-analysis of 5,971 patients. Catheter Cardiovasc Interv 2015; 86:518-27. [PMID: 25641565 DOI: 10.1002/ccd.25867] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/25/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is conflicting evidence on the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with postoperative acute kidney injury (AKI). Therefore, we conducted a meta-analysis on the impact of AKI on clinical outcomes after TAVI. METHODS AND RESULTS Twenty-four studies including 5,971 patients were analyzed. The mean incidence of AKI in this population was 22.1% ± 11.2. Postoperative AKI significantly increased early (odds ratio [OR] 5.09; 95% confidence interval [CI], 4.03-6.43 and OR 6.14; 95% CI, 3.26-11.55) and 1-year (OR 3.27; 95% CI, 2.42-4.42 and OR 1.93; 95% CI, 1.38-2.71) all-cause and cardiovascular mortality respectively, but also early myocardial infarction (OR 3.30; 95% CI, 1.44-7.57), life-threatening bleeding (OR 2.90; 95% CI, 1.67-5.05), need for transfusion (OR 2.42; 95% CI, 1.96-2.99), and dialysis (OR 14.35; 95% CI, 6.21-33.20), with a non-significant increase of stroke (OR 1.66; 95% CI, 0.94-2.95), hospitalization (mean difference [MD] 1.73; 95% CI, -0.31 to 3.77) and contrast medium received (MD 4.74; 95% CI, -2.33 to 11.81). CONCLUSIONS Postoperative AKI seems to significantly worsen TAVI prognosis. The results of the present meta-analysis should be considered hypothesis-generating and future studies on risk stratification, prevention, and postoperative management are needed.
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Affiliation(s)
- Giuseppe Gargiulo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Anna Sannino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Cinzia Perrino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Piera Capranzano
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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van Rosendael PJ, Kamperidis V, van der Kley F, Katsanos S, Al Amri I, Regeer MV, Schalij MJ, de Weger A, Marsan NA, Bax JJ, Delgado V. Atherosclerosis burden of the aortic valve and aorta and risk of acute kidney injury after transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr 2015; 9:129-38. [PMID: 25819195 DOI: 10.1016/j.jcct.2015.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atheroembolic renal disease, due to dislodgement of cholesterol crystals during maneuvering of a large catheter across the aorta and deployment of the transcatheter prosthesis within a calcified aortic valve, may be one of the pathophysiological mechanisms of acute kidney injury (AKI) complicating transcatheter aortic valve implantation (TAVI). OBJECTIVE To investigate the association between the atherosclerotic burden and plaque characteristics of the aortic valve and thoracic aorta, evaluated with multidetector CT (MDCT), and the occurrence of AKI after TAVI. METHODS Aortic valve calcification, atherosclerosis burden, and plaque characteristics of the thoracic aorta (including aortic root, ascending aorta, aortic arch, and descending aorta) were analyzed in preprocedural MDCT data of 210 TAVI patients (age, 81 ± 7.1 years; 51.4% men). The thoracic aorta was divided into ascending aorta, aortic arch, and descending thoracic aorta which was further divided into 5 to 8 segments according to the posterior intercostal arteries. Each segment where the maximum wall thickness exceeded ≥ 2 mm was defined as diseased segment with atherosclerotic plaque. Aortic atherosclerosis burden was defined as the proportion of thoracic aortic segments with atherosclerosis. AKI was defined by a creatinine level ≥ 1.5 × baseline or ≥ 26.4 μmol/L above baseline. MDCT data were correlated with the occurrence of postprocedural AKI in a multivariate logistic regression model. RESULTS Postprocedural AKI occurred in 51 patients (24.3%). In patients with AKI, the burden of overall (87.5% [75%-90%] vs 71.4% [50%-87.5%]; P < .001) and noncalcified atherosclerosis (42.9% [22.2%-62.5%] vs 12.5% [0%-28.6%]; P < .001) and the maximum plaque thickness (5.7 ± 1.8 mm vs 4.5 ± 1.4 mm; P < .001) were larger compared with patients without AKI. The burden of noncalcified atherosclerosis remained independently associated with AKI (odds ratio, 1.03 [per each 1% of increase in aortic segments with noncalcified atherosclerosis]; 95% confidence interval 1.01-1.05; P = .006) after adjusting for baseline renal function, logistic EuroSCORE, and procedural access. In contrast, aortic valve calcification was not independently associated with AKI. CONCLUSION In patients undergoing TAVI, occurrence of postprocedural AKI was associated with the extent of noncalcified atherosclerotic plaque burden of the thoracic aorta.
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Affiliation(s)
- Philippe J van Rosendael
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Vasileios Kamperidis
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Frank van der Kley
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Spyridon Katsanos
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Ibtihal Al Amri
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Madelien V Regeer
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Martin J Schalij
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Arend de Weger
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Victoria Delgado
- Department of Cardiology and Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands.
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Voigtländer L, Schewel J, Martin J, Schewel D, Frerker C, Wohlmuth P, Thielsen T, Kuck KH, Schäfer U. Impact of kidney function on mortality after transcatheter valve implantation in patients with severe aortic valvular stenosis. Int J Cardiol 2014; 178:275-81. [PMID: 25464269 DOI: 10.1016/j.ijcard.2014.10.172] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 09/06/2014] [Accepted: 10/27/2014] [Indexed: 11/27/2022]
Abstract
AIMS Transcatheter aortic valve implantation (TAVI) is an accepted alternative for patients with severe aortic valve stenosis who cannot undergo surgery. Acute kidney injury (AKI) is a serious complication in any invasive cardiovascular intervention. The objectives of the study were to determine (i) the influence of kidney function before TAVI and (ii) the impact of changes in kidney function after TAVI, including acute kidney injury (AKI), on mortality. METHODS AND RESULTS A total of 540 patients undergoing TAVI were included. Patients were divided into three groups according to glomerular filtration rate (GFR) before TAVI (A: normal renal function i.e. GFR ≥60ml/min; B: impaired renal function i.e. GFR 30-59ml/min; C: severe impaired renal function i.e. GFR <30ml/min). Multivariate analysis showed a significant impact of GFR on mortality (p<0.0008). Subgroup analysis showed significant differences between the groups in 30-day (A: 5.4%, B: 9.0%, C: 25.0%) and 12-month mortality (A: 15.0%, B: 32.0%, C: 49%). Patients who had an increase in GFR after TAVI by more than 22% (p=0.0068) had an improved survival rate, whereas a decrease in GFR by more than 15% was associated with an increased mortality rate (p=0.0051). AKI occurred in 30 patients (5.6%), of which 22 patients (73.3%) died within 12months. CONCLUSION Outcome is significantly related to pre-procedural kidney function. In addition, changes in kidney function after TAVI have a significant impact on mortality. Due to a very poor prognosis in patients with AKI, any effort to prevent this serious complication after TAVI needs to be taken.
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Affiliation(s)
- Lisa Voigtländer
- Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany
| | - Jury Schewel
- Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany
| | - Julia Martin
- Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany
| | - Dimitry Schewel
- Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany
| | - Christian Frerker
- Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany
| | - Peter Wohlmuth
- Asklepios Proresearch, Clinical Research and Development, Hamburg, Germany
| | - Thomas Thielsen
- Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany
| | - Karl-Heinz Kuck
- Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany
| | - Ulrich Schäfer
- Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany.
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Maisano F, Taramasso M, Nietlispach F. Prognostic influence of paravalvular leak following TAVI: is aortic regurgitation an active incremental risk factor or just a mere indicator? Eur Heart J 2014; 36:413-5. [PMID: 25336227 DOI: 10.1093/eurheartj/ehu410] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Francesco Maisano
- Cardiovascular Surgery Clinic, Herzzentrum, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Maurizio Taramasso
- Cardiovascular Surgery Clinic, Herzzentrum, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Fabian Nietlispach
- Cardiology Clinic, Herzzentrum, UniversitätsSpital Zürich, Zürich, Switzerland
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