High Incidence of Renal Artery Stenosis in Post TAVI Acute Kidney Injury - The 63rd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery 12-13 April 2016, David Intercontinental Hotel, Tel-Aviv, Israel

Orly Goitein ¹ Orna Komisar ¹ Israel Barbash ² Victor Guetta ² Amit Segev ² Paul Fefer ² Elad Asher ² Sagit Ben Zikri ² Anat Berkovitz ² Ashraf Hamdan ³ Elio Di Segni ¹ Boris Orlov ² Eli Konen ¹ Yafim Brodov ^1,2

¹Diagnostic Imaging, Sheba Medical Center, Ramat gan
²Heart instiute, Sheba Medical Center, Ramat Gan
³Department of Cardiology, Rabin Medical Center, Petach- Tikva

Background: Acute kidney injury (AKI) is a frequent complication after transcatheter aortic valve implantation (TAVI) and affects outcome and survival. The presence of atherosclerotic disease in the renal arteries might be related to post TAVI AKI. No studies have evaluated the renal arteries for the presence of renal artery stenosis (RAS) in pre TAVI evaluation.

Objective: To investigate whether the presence and extent of atherosclerotic disease in the renal arteries is related to post TAVI AKI.

Methods: AKI was considered according Valve Academic Research Consortium -2 (VARC-2). A post TAVI non-AKI cohort (n = 34, serum creatinine > 1.4 mg/dl, mean age 82 ± 7; 49% female) and post TAVI AKI cohort (VARC 2; mean age 82±6; 60% female) were compared for presence and severity of RAS by using MDCT curved multiplanar reformat along the renal arteries. RAS was graded as < 50% or ≥ 50% in the renal artery ostia and middle part.

Results: RAS ≥ 50% on any side was demonstrated in 3 patients (4%) and 6 patients (7%) in the non-AKI and AKI groups (P=0.0014), respectively. RAS ≥ 25% was demonstrated in 9 patients (13%) and 16 patients (18%) in the non AKI and AKI groups (P=0.0003), respectively.

Conclusion: This study demonstrated statistically significant higher rates of RAS in post TAVI AKI patients as compared with non- AKI patients. This finding suggests that the presence and severity of RAS prior to the TAVI procedure might play a role in the development of post TAVI AKI. Thus, we propose the renal artery evaluation should be warranted in the pre TAVI evaluation and further studies addressing this issue are needed.