Transapical versus transfemoral approach and risk of acute kidney injury following transcatheter aortic valve replacement: a propensity-adjusted analysis.

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
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

Ren Fail 2017 Nov 21;39(1):13-18. Epub 2016 Oct 21.

a Department of Internal Medicine, Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA.

Background: The aim of this study was to compare the incidence of post-procedural acute kidney injury (AKI) and other renal outcomes in patients undergoing transapical (TA) and transfemoral (TF) approaches for transcatheter aortic valve replacement (TAVR).

Methods: All consecutive adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital were included. AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression adjustment, propensity score stratification, and propensity matching were performed to assess the independent association between procedural approach and AKI.

Results: Of 366 included patients, 171 (47%) underwent TAVR via a TA approach. AKI occurrence in this group was significantly higher compared to the TF group (38% vs. 18%, pā€‰<ā€‰.01). The TA approach remained significantly associated with increased risk of AKI after logistic regression (OR 3.20; CI 1.68-4.36) and propensity score adjustment: OR 2.83 (CI 1.66-4.80) for stratification and 3.82 (CI 2.04-7.44) for matching. Nonetheless, there was no statistically significant difference among the TA and TF groups with respect to major adverse kidney events (MAKE) or estimated glomerular filtration rate (eGFR) at six months post-procedure.

Conclusion: In a cohort of patients undergoing TAVR for aortic stenosis, a TA approach significantly increases the AKI risk compared with a TF approach. However, the TAVR approach did not affect severe renal outcomes or long-term renal function.

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Source
http://dx.doi.org/10.1080/0886022X.2016.1244072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014512PMC

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November 2017
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References

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Article in J Thorac Dis
Scherner M et al.
J Thorac Dis 2015

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