Results
A total of 131 consecutive patients (age, 80.8 ± 6 years; 42% male; Euroscore II, 10.27 ± 6.9) who underwent TAVI in the same center were included. Baseline characteristics are shown in Table 1.
A successful procedure was accomplished in 127 patients (97%). The procedure was totally percutaneous in 102 patients (77.8%), whereas a surgical femoral artery exposure was performed in 29 patients (22.2%). The procedure characteristics are shown in Table 2.
Glomerular filtration rate was 62.09 ± 22 mL/min/1.73 m at baseline, 62.7 ± 25 mL/min/1.73 m after the procedure, and 68.03 ± 25 mL/min/1.73 m upon discharge (Table 3). Upon discharge, 89 patients (68%) had improved GFR compared with the basal rate. Average improvement in GFR was 5.71 ± 15 mL/min/1.73 m (confidence interval [CI], 2.23–9.2;P=.01).
A total of 17 patients (13%) developed AKI after TAVI. Of these patients, 11 improved before discharge, only 6 patients (4.5%) persisted with a deterioration of GFR >25%, and only 1 patient required permanent dialysis.
Patients who developed AKI had a longer hospitalization with a median of 7 days (IQR, 5–12 days) vs 3 days (IQR, 2–6 days); P=.01. There were no differences by approach technique with a similar AKI incidence in surgical artery exposure (17.9%) vs total percutaneous approach (12.9%; P=.58). Patients under general anesthesia presented with a similar incidence of AKI compared with those on local anesthesia (15% vs 16.7%, respectively; P=.74) (Table 4).
Three of the 17 patients who developed AKI died from the procedure in 30 days, whereas 1 of the patients who did not develop AKI died (17.6% vs 0.9%; P=.01). All 3 patients died of multiple organ dysfunction with oliguric acute kidney injury. One of them had suffered a retroperitoneal hematoma after the procedure, requiring conservative non-surgical treatment.
In a logistic regression model, variables such as age, gender, body mass index, and those with P≤.20 in the univariate analysis were introduced. Previously released papers have found an association between AKI and hypertension, chronic obstructive pulmonary disease, and blood transfusion; thus, these variables were also included in the model.
According to this model, the only independent predictor of AKI after TAVI was Euroscore II (odds ratio [OR], 1.192; CI, 1.042–1.326; P=.01). The presence of coronary artery disease showed a strong trend, but was not statistically significant (OR, 10.528; CI, 0.707–157; P=.09).