AKI after Transcatheter or Surgical Aortic Valve Replacement.

Authors:
Charat Thongprayoon
Charat Thongprayoon
Mayo Clinic
Phoenix | United States
Wisit Cheungpasitporn
Wisit Cheungpasitporn
Bassett Medical Center and Columbia University College of Physicians and Surgeons
United States
Narat Srivali
Narat Srivali
Bassett Medical Center and Columbia University College of Physicians and Surgeons
United States
Dr Andrew M Harrison, MD, PhD
Dr Andrew M Harrison, MD, PhD
Mayo Clinic
Postdoctoral researcher
Clinical Informatics
Rochester, MN | United States
Tina M Gunderson
Tina M Gunderson
Division of Biomedical Statistics and Informatics
Wonngarm Kittanamongkolchai
Wonngarm Kittanamongkolchai
Bassett Medical Center and Columbia University College of Physicians and Surgeons
United States
Kevin L Greason
Kevin L Greason
Mayo Clinic
Dubai | United Arab Emirates
Kianoush B Kashani
Kianoush B Kashani
Mayo Clinic
United States

J Am Soc Nephrol 2016 06 20;27(6):1854-60. Epub 2015 Oct 20.

Division of Nephrology and Hypertension, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine,

Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis who are at high risk of perioperative mortality. Previous studies showed increased risk of postoperative AKI with TAVR, but it is unclear whether differences in patient risk profiles confounded the results. To conduct a propensity-matched study, we identified all adult patients undergoing isolated aortic valve replacement for aortic stenosis at Mayo Clinic Hospital in Rochester, Minnesota from January 1, 2008 to June 30, 2014. Using propensity score matching on the basis of clinical characteristics and preoperative variables, we compared the postoperative incidence of AKI, defined by Kidney Disease Improving Global Outcomes guidelines, and major adverse kidney events in patients treated with TAVR with that in patients treated with SAVR. Major adverse kidney events were the composite of in-hospital mortality, use of RRT, and persistent elevated serum creatinine ≥200% from baseline at hospital discharge. Of 1563 eligible patients, 195 matched pairs (390 patients) were created. In the matched cohort, baseline characteristics, including Society of Thoracic Surgeons risk score and eGFR, were comparable between the two groups. Furthermore, no significant differences existed between the TAVR and SAVR groups in postoperative AKI (24.1% versus 29.7%; P=0.21), major adverse kidney events (2.1% versus 1.5%; P=0.70), or mortality >6 months after surgery (6.0% versus 8.3%; P=0.51). Thus, TAVR did not affect postoperative AKI risk. Because it is less invasive than SAVR, TAVR may be preferred in high-risk individuals.

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Source
http://dx.doi.org/10.1681/ASN.2015050577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884118PMC

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June 2016
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