Strategies to Avoid TAVI-related Acute Kidney Injury

Acute kidney injury (AKI) is relatively common in patients undergoing transcatheter aortic valve implantation (TAVI) and has been associated with increased mortality and worse outcomes. The administration of iodinated contrast media in an elderly population with increased rates of chronic kidney injury and heart failure, the risk of hemodynamic compromise and the use of large catheters intra-procedurally make patients undergoing TAVI particularly vulnerable to renal insults and AKI. Furthermore, these patients are commonly exposed to iodinated contrast media during diagnostic and possible interventional procedures pre-TAVI. While risk factors such as baseline comorbidities are non-modifiable, others such as administration of nephrotoxic medications, the type and amount of contrast medium and the catheters size can be avoided, modified and improved. In addition, numerous other interventions such as volume expansion and possibly medications can prevent contrast related kidney injury. In this review, we sought to focus on strategies aiming at reducing the incidence of TAVI-related AKI.