The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Novel Predictors of Acute Kidney Injury in Patients Undergoing TAVR

Sharon Cohen 2 Doron Sudarsky 1,2 Fabio Kusniec 1,2 Shemy Carasso 1,2 Liza Grosman-Rimon 1,2 Edo Y. Birati 1,2 Alla Lubovich 1,2
1Cardiovascular Institute, B Padeh Medicla Center, Poriya, Israel
2Bar Ilan University, The Azrieli Faculty of Medicine in the Galilee, Israel

Introduction:

Catheter based intravascular procedures are associated with higher risk of acute kidney injury compared with non-invasive imaging procedures that utilize intravenous contrast injection. The term "catheter induced nephropathy" have been proposed instead of "contrast induced nephropathy".

Possible pathophysiologic mechanisms have been proposed, including embolization of cholesterol crystals and aortic plaque fragments into the renal microvasculature.

TAVR patients are elderly patients with established vascular disease and severely calcified aortic valve (AV). There is excessive catheter associated manipulation of aorta and aortic valve during the TAVR procedure.

We aimed to investigate whether severity of aortic stenosis, degree of calcification of the aortic valve and CHA2DS2VASC score as a general cardiovascular risk score are associated with increased risk of acute kidney injury (AKI).

Methods:

In this retrospective study, we included patients who underwent TAVR procedure at an academic institution between January 1 2018 and December 31 2019. Four patients on chronic dialysis were excluded from the analysis. We defined AKI as a 25 % relative or 0.5 mg/dl absolute increase in serum creatinine 48 hours after procedure

We performed a logistic regression analysis of AV calcium score and area as defined by CCTA, GFR less than 50 ml/min, CHA2DS2VASC SCORE and contrast volume delivered during procedure as possible predictors of AKI.

Results:

A total of 118 consecutive patients with severe aortic stenosis (AS) were included in this study. The mean age of the patients was 79 years (range 49-95). Forty-nine percent of the patients were female. Twelve patients (10%) developed AKI during 48 hours post procedure. Only GFR less than 50 ml/min was a significant predictor of AKI in our cohort (OR=8,2; p=0.004). Calcium score, aortic valve area and contrast volume did not correlated with the development of AKI (p=0.993,0.995,0.993, respectively).

Conclusion:

In this small single center cohort of TAVR patients, severity of aortic valve disease was not associated with development of AKI.









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