Intra-operative contrast-agent burden >99 ml during trans-apical aortic valve implantation was an independent risk factor for postoperative acute kidney injury (OR 2.3, p=0.038).
Cohort (n=270)
What are the risk factors for acute kidney injury and need for renal replacement therapy after trans-apical aortic valve implantation?
Intra-operative contrast agent volume during trans-apical aortic valve implantation is an independent risk factor for postoperative acute kidney injury, highlighting the need to minimize contrast exposure.
Effect estimate: OR 2.3
p-value: p=0.038
OBJECTIVE: Contrast agent is a potential risk factor for acute kidney injury (AKI). Little is known about the incidence of contrast-induced nephropathy (CIN) after trans-apical aortic valve implantation (TA-AVI) and on the impact of contrast exposure during preoperative computed tomography (CT) scan and cardiac catheterization. METHODS: A total of 270 consecutive high-risk patients received TA-AVI for symptomatic aortic valve stenosis during a 3-year period. Different preoperative, peri-procedural, and postoperative variables were analyzed by uni- and multivariate logistic regression concerning incidence of early (99 ml (OR=2.3, p=0.038), new thrombocytopenia (OR=4.4, p=0.005) and pathological leucocyte count (OR=2.8, p=0.009) were independent risk factors for this event. Early (within 1-7 days before TA-AVI) preoperative CT and cardiac catheterization did not significantly increase incidence of RRT or AKI. Short-term and long-term survival was explicitly lower in the AKI and in the RRT groups (p<0.001 each). CONCLUSIONS: GFR improves after TA-AVI. Postoperative AKI and RRT depend on the amount of intra-operative contrast agent. These results strongly support the need for intra-operative tools to reduce contrast-agent exposition during TA-AVI.
Linden et al. (Sat,) conducted a cohort in symptomatic aortic valve stenosis (n=270). Trans-apical aortic valve implantation (TA-AVI) and contrast agent exposure was evaluated on Early (<7 days) acute kidney injury (AKI) (OR 2.3, p=0.038). Intra-operative contrast-agent burden >99 ml during trans-apical aortic valve implantation was an independent risk factor for postoperative acute kidney injury (OR 2.3, p=0.038).
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