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Postoperative Acute Kidney Injury After Transcatheter Aortic Valve Replacement.

Sebastian Ayala1, Zhengmin Ma2, Ke Peng2

  • 1Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA.

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Post-transcatheter aortic valve replacement acute kidney injury (TAVR AKI) affects up to 1 in 6 patients. Modifiable risk factors like hypotension and blood transfusions significantly impact TAVR AKI incidence and patient mortality.

Keywords:
Acute kidney injuryCardiacTAVR

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Area of Science:

  • Cardiology
  • Nephrology
  • Surgical Outcomes

Background:

  • Post-transcatheter aortic valve replacement acute kidney injury (TAVR AKI) is a significant complication, affecting up to 1 in 6 patients.
  • A substantial proportion of patients undergoing TAVR have pre-existing chronic kidney disease (CKD), increasing their risk of AKI.
  • TAVR AKI is an independent predictor of both short-term and long-term mortality.

Purpose of the Study:

  • To review the current literature on the incidence of TAVR AKI.
  • To evaluate modifiable and non-modifiable risk factors associated with perioperative TAVR AKI.
  • To provide recommendations for mitigating TAVR AKI risk.

Main Methods:

  • Literature review of studies on TAVR AKI incidence and risk factors.
  • Analysis of perioperative factors including access method, hypotension, and blood transfusion.
  • Synthesis of findings to identify key associations and potential interventions.

Main Results:

  • The incidence of post-TAVR AKI is reported as high as 1 in 6 patients.
  • Transfemoral (TF) access is associated with significantly less AKI compared to transapical (TA) or transaortic (TaO) approaches.
  • Patients receiving packed red blood cell (pRBC) transfusions had a higher incidence of TAVR AKI (55%) compared to those who did not (21%).

Conclusions:

  • Modifiable perioperative factors, including access method, hypotension, and blood transfusion, play a crucial role in TAVR AKI.
  • Preventing hypotension and judicious use of blood transfusions are key strategies to reduce TAVR AKI.
  • Optimizing perioperative management can improve outcomes for patients undergoing TAVR.