Postoperative Acute Kidney Injury After Transcatheter Aortic Valve Replacement

The purpose of this review serves to briefly summarize the current literature surveying the incidence of posttranscatheter aortic valve replacement acute kidney injury (TAVR AKI). Furthermore, this review extends itself to evaluate and potentially address modifiable risk factors, while acknowledging non-modifiable risk factors in the perioperative setting. These modifiable risk factors include but are not limited to access method, perioperative hypotension events, and need for blood transfusion in the setting of preoperative anemia.

Recent retrospective studies have highlighted the incidence of post-TAVR AKI, citing as high as 1 in 6 patients. Despite exclusion of patients with end-stage renal disease (ESRD) from pivotal TAVR trials, data shows that over 50% of high-risk patients suffer > 3a chronic kidney disease (CKD) and about 10% of them suffer > 4 CKD, with the risk of AKI increasing significantly at each stage of CKD advancement. Meta-analyses have shown that patients who underwent TAVR via transfemoral (TF) approach compared to those who had transapical (TA) or transaortic (TaO) approach had significantly less AKI post-TAVR. Furthermore, in patients who developed post-TAVR AKI, 55% of them had received packed red blood cell (pRBC) transfusion, while only 21% of the patients who did not receive pRBCs develop post-TAVR AKI (p = .002). Post-TAVR AKI has been shown in multiple studies that it is an independent risk factor for increased short term and long-term mortality. These findings together highlight both the clinical significance and continued perioperative vigilance to further improve clinical outcomes.

This review aims to summarize recent literature regarding the association of AKI in the perioperative setting of TAVR. In addition, it parses the risk factors into both modifiable and non-modifiable risk factors. Furthermore, it provides some recommendations including procedure approach, appreciating transfusion implication, and most importantly, preventing hypotension events in the perioperative period.