Incidence and effect of acute kidney injury after transcatheter aortic valve replacement using the new valve academic research consortium criteria

Philippe Genereux, Susheel K. Kodali, Philip Green, Jean Michel Paradis, Benoit Daneault, Garvey Rene, Irene Hueter, Isaac Georges, Ajay Kirtane, Rebecca T. Hahn, Craig Smith, Martin B. Leon, Mathew R. Williams

Research output: Contribution to journalArticle

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Abstract

Acute kidney injury (AKI) is associated with a poor prognosis after transcatheter aortic valve replacement (TAVR). A paucity of data exists regarding the incidence and effect of AKI after TAVR using the new recommended Valve Academic Research Consortium criteria. At Columbia University Medical Center, 218 TAVR procedures (64.2% transfemoral, 35.8% transapical) were performed from 2008 to July 2011. The creatinine level was evaluated daily until discharge. Using the Valve Academic Research Consortium definitions, the 30-day and 1-year outcomes were compared between patients with significant AKI (AKI stage 2 or 3) and those without significant AKI (AKI stage 0 or 1). Significant AKI occurred in 18 patients (8.3%). Of these 18 patients, 10 (55.6%) had AKI stage 3 and 9 (50%) required dialysis. AKI was associated with a lower baseline mean transvalvular gradient (37.6 ± 11.4 vs 45.6 ± 14.8 mm Hg for no AKI, p = 0.03). After TAVR, the AKI group had a greater hemoglobin decrease (3.6 ± 2.0 vs 2.4 ± 1.3 g/dl, p = 0.01), greater white blood cell elevation at 72 hours (21.09 ± 12.99 vs 13.18 ± 4.82 × 103/μl, p = 0.001), a more severe platelet decrease (118 ± 40 vs 75 ± 43 × 103/μl, p <0.0001), and longer hospitalization (10.7 ± 6.4 vs 7.7 ± 8.5 days, p <0.001). One stroke (5.6%) occurred in the AKI group compared with 3 (1.5%) in the group without AKI (p = 0.29). The 30-day and 1-year rates of death were significantly greater in the AKI group than in the no-AKI group (44.4% vs 3.0%, hazard ratio 18.1, 95% confidence interval 6.25 to 52.20, p <0.0001; and 55.6% vs 16.0%, hazard ratio 6.32, 95% confidence interval 3.06 to 13.10, p <0.0001, respectively). Periprocedural life-threatening bleeding was the strongest predictor of AKI after TAVR. In conclusion, the occurrence of AKI, as defined by the Valve Academic Research Consortium criteria, is associated with periprocedural complications and a poor prognosis after TAVR.

Original languageEnglish (US)
Pages (from-to)100-105
Number of pages6
JournalAmerican Journal of Cardiology
Volume111
Issue number1
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Acute Kidney Injury
Incidence
Research
Transcatheter Aortic Valve Replacement
Confidence Intervals
Dialysis
Creatinine

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Kodali, Susheel K. ; Green, Philip ; Paradis, Jean Michel ; Daneault, Benoit ; Rene, Garvey ; Hueter, Irene ; Georges, Isaac ; Kirtane, Ajay ; Hahn, Rebecca T. ; Smith, Craig ; Leon, Martin B. ; Williams, Mathew R. / Incidence and effect of acute kidney injury after transcatheter aortic valve replacement using the new valve academic research consortium criteria. In: American Journal of Cardiology. 2013 ; Vol. 111, No. 1. pp. 100-105.
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abstract = "Acute kidney injury (AKI) is associated with a poor prognosis after transcatheter aortic valve replacement (TAVR). A paucity of data exists regarding the incidence and effect of AKI after TAVR using the new recommended Valve Academic Research Consortium criteria. At Columbia University Medical Center, 218 TAVR procedures (64.2{\%} transfemoral, 35.8{\%} transapical) were performed from 2008 to July 2011. The creatinine level was evaluated daily until discharge. Using the Valve Academic Research Consortium definitions, the 30-day and 1-year outcomes were compared between patients with significant AKI (AKI stage 2 or 3) and those without significant AKI (AKI stage 0 or 1). Significant AKI occurred in 18 patients (8.3{\%}). Of these 18 patients, 10 (55.6{\%}) had AKI stage 3 and 9 (50{\%}) required dialysis. AKI was associated with a lower baseline mean transvalvular gradient (37.6 ± 11.4 vs 45.6 ± 14.8 mm Hg for no AKI, p = 0.03). After TAVR, the AKI group had a greater hemoglobin decrease (3.6 ± 2.0 vs 2.4 ± 1.3 g/dl, p = 0.01), greater white blood cell elevation at 72 hours (21.09 ± 12.99 vs 13.18 ± 4.82 × 103/μl, p = 0.001), a more severe platelet decrease (118 ± 40 vs 75 ± 43 × 103/μl, p <0.0001), and longer hospitalization (10.7 ± 6.4 vs 7.7 ± 8.5 days, p <0.001). One stroke (5.6{\%}) occurred in the AKI group compared with 3 (1.5{\%}) in the group without AKI (p = 0.29). The 30-day and 1-year rates of death were significantly greater in the AKI group than in the no-AKI group (44.4{\%} vs 3.0{\%}, hazard ratio 18.1, 95{\%} confidence interval 6.25 to 52.20, p <0.0001; and 55.6{\%} vs 16.0{\%}, hazard ratio 6.32, 95{\%} confidence interval 3.06 to 13.10, p <0.0001, respectively). Periprocedural life-threatening bleeding was the strongest predictor of AKI after TAVR. In conclusion, the occurrence of AKI, as defined by the Valve Academic Research Consortium criteria, is associated with periprocedural complications and a poor prognosis after TAVR.",
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Genereux, P, Kodali, SK, Green, P, Paradis, JM, Daneault, B, Rene, G, Hueter, I, Georges, I, Kirtane, A, Hahn, RT, Smith, C, Leon, MB & Williams, MR 2013, 'Incidence and effect of acute kidney injury after transcatheter aortic valve replacement using the new valve academic research consortium criteria', American Journal of Cardiology, vol. 111, no. 1, pp. 100-105. https://doi.org/10.1016/j.amjcard.2012.08.057

Incidence and effect of acute kidney injury after transcatheter aortic valve replacement using the new valve academic research consortium criteria. / Genereux, Philippe; Kodali, Susheel K.; Green, Philip; Paradis, Jean Michel; Daneault, Benoit; Rene, Garvey; Hueter, Irene; Georges, Isaac; Kirtane, Ajay; Hahn, Rebecca T.; Smith, Craig; Leon, Martin B.; Williams, Mathew R.

In: American Journal of Cardiology, Vol. 111, No. 1, 01.01.2013, p. 100-105.

Research output: Contribution to journalArticle

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AU - Kodali, Susheel K.

AU - Green, Philip

AU - Paradis, Jean Michel

AU - Daneault, Benoit

AU - Rene, Garvey

AU - Hueter, Irene

AU - Georges, Isaac

AU - Kirtane, Ajay

AU - Hahn, Rebecca T.

AU - Smith, Craig

AU - Leon, Martin B.

AU - Williams, Mathew R.

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N2 - Acute kidney injury (AKI) is associated with a poor prognosis after transcatheter aortic valve replacement (TAVR). A paucity of data exists regarding the incidence and effect of AKI after TAVR using the new recommended Valve Academic Research Consortium criteria. At Columbia University Medical Center, 218 TAVR procedures (64.2% transfemoral, 35.8% transapical) were performed from 2008 to July 2011. The creatinine level was evaluated daily until discharge. Using the Valve Academic Research Consortium definitions, the 30-day and 1-year outcomes were compared between patients with significant AKI (AKI stage 2 or 3) and those without significant AKI (AKI stage 0 or 1). Significant AKI occurred in 18 patients (8.3%). Of these 18 patients, 10 (55.6%) had AKI stage 3 and 9 (50%) required dialysis. AKI was associated with a lower baseline mean transvalvular gradient (37.6 ± 11.4 vs 45.6 ± 14.8 mm Hg for no AKI, p = 0.03). After TAVR, the AKI group had a greater hemoglobin decrease (3.6 ± 2.0 vs 2.4 ± 1.3 g/dl, p = 0.01), greater white blood cell elevation at 72 hours (21.09 ± 12.99 vs 13.18 ± 4.82 × 103/μl, p = 0.001), a more severe platelet decrease (118 ± 40 vs 75 ± 43 × 103/μl, p <0.0001), and longer hospitalization (10.7 ± 6.4 vs 7.7 ± 8.5 days, p <0.001). One stroke (5.6%) occurred in the AKI group compared with 3 (1.5%) in the group without AKI (p = 0.29). The 30-day and 1-year rates of death were significantly greater in the AKI group than in the no-AKI group (44.4% vs 3.0%, hazard ratio 18.1, 95% confidence interval 6.25 to 52.20, p <0.0001; and 55.6% vs 16.0%, hazard ratio 6.32, 95% confidence interval 3.06 to 13.10, p <0.0001, respectively). Periprocedural life-threatening bleeding was the strongest predictor of AKI after TAVR. In conclusion, the occurrence of AKI, as defined by the Valve Academic Research Consortium criteria, is associated with periprocedural complications and a poor prognosis after TAVR.

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