Factors associated with acute kidney injury in patients undergoing transcatheter aortic valve implantation: Short-term outcomes and impact of right heart failure

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) was developed as an alternative to surgery for symptomatic, high-risk patients with severe aortic stenosis (AS). Acute kidney injury, a major complication of TAVI, is associated with a poor prognosis. In our study, we planned to investigate the effect of right heart failure on the development of acute kidney injury after TAVI and other factors contributing to the development of AKI.
METHODS: Between January 2015 and December 2020, 198 patients who underwent TAVI due to severe symptomatic aortic stenosis at Dr. Siyami Ersek Cardiovascular Surgery Hospital were screened. Local ethics committee approval was obtained (HNEAH-KAEK 2021/134-3343). Transthoracic echocardiographic findings and laboratory evaluations were recorded. Patients were evaluated according to Acute Kidney Injury Network (AKIN) criteria.
RESULTS: The rate of AKI after TAVI was found to be 41.9%. The mean age of patients who developed AKI was higher (80.90±6.8). AKI development rates were higher in the female gender (68.7%) and patients with hypertension (44.8%). It was observed that the risk of developing AKI was higher in patients who underwent TAVI and developed AKI afterwards, es- pecially in patients with stage-3 and stage-4 advanced CKD before TAVI (p<0.01) We did not find an independent relationship between AKI and right-heart failure in our analysis.
CONCLUSION: We observed that chronic kidney disease before TAVI, advanced age, and female gender are important determinants of the development of AKI after TAVI. Although a relationship between TAVI and right heart failure has not been demonstrated, large-scale studies are needed in the future.

Transkateter aort kapak implantasyonu yapilan hastalarda akut böbrek hasarýyla iliþkili faktörler: Kýsa dönem sonuçlarý ve sað kalp yetersizliðinin etkisi

Giriþ: Transkateter aort kapak implantasyonu (TAVI), þiddetli aort stenozu (AS) olan semptomatik, yüksek riskli hastalar için cerrahiye alternatif olarak geliþtirilmiþtir. TAVI'nin önemli bir komplikasyonu olan akut böbrek hasarý ötü prognozla iliþkilidir. Çalýþmamýzda sað kalp yetersizliðinin TAVI sonrasý akut böbrek hasarý geliþimine etkisini ve ABH geliþimine katkýda bulunan diðer faktörleri araþtýrmayý planladýk.
Yöntem: Ocak 2015 ile Aralýk 2020 tarihleri arasýnda Dr. Siyami Ersek Kalp ve Damar Cerrahisi Hastanesi'nde ciddi semptomatik aort darlýðý nedeniyle TAVI yapýlan 198 hasta tarandý. Yerel etik kurul onayý alýndý (HNEAH-KAEK 2021/134-3343) Transtorasik ekokardiyografik bulgular ve laboratuvar deðerlendirmesi kaydedildi. Hastalar Akut Böbrek Hasarý Aðý(AKIN) kriterlerine göre deðerlendirildi
Bulgular: TAVI sonrasý AKI oraný %41,9 olarak belirlendi. AKI geliþen hastalarýn yaþ ortalamasý daha yüksekti (80,90±6,8). AKI geliþme oranlarý kadýn cinsiyette (%68,7) ve hipertansiyonlu hastalarda (%44,8) daha yüksekti. TAVÝ uygulanan ve sonrasýnda AKI geliþen hastalarda, özellikle TAVÝ öncesi evre-3 ve evre-4 ileri kronik böbrek hastalýðý olan hastalarda AKI geliþme riskinin daha yüksek olduðu görüldü (p<0,000). ) Analizimizde AKI ile sað kalp yetmezliði arasýnda baðýmsýz bir iliþki bulamadýk.
Sonuç: TAVI öncesi kronik böbrek hastalýðý, ileri yaþ ve kadýn cinsiyetin TAVI sonrasý AKI geliþiminde önemli belirleyiciler olduðunu gözlemledik.TAVÝ ile sað kalp yetmezliði arasýnda iliþki gösterilememiþ olsa da gelecekte geniþ çaplý çalýþmalara ihtiyaç vardýr. (NCI-2023-12-7)