Transapical TAVR significantly increased the risk of acute kidney injury compared with a transfemoral approach (38% vs. 18%, p < 0.01; matched OR 3.82, 95% CI 2.04-7.44).
Cohort (n=366)
No
Does a transapical approach increase the risk of acute kidney injury compared to a transfemoral approach in patients undergoing TAVR for aortic stenosis?
The transapical approach for TAVR is associated with a significantly higher risk of acute kidney injury compared to the transfemoral approach, although it does not appear to affect long-term renal function at 6 months.
Effect estimate: OR 3.82 (95% CI 2.04-7.44)
Absolute Event Rate: 38% vs 18%
p-value: p=< .01
BACKGROUND: The aim of this study was to compare the incidence of post-procedural acute kidney injury (AKI) and other renal outcomes in patients undergoing transapical (TA) and transfemoral (TF) approaches for transcatheter aortic valve replacement (TAVR). METHODS: All consecutive adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital were included. AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression adjustment, propensity score stratification, and propensity matching were performed to assess the independent association between procedural approach and AKI. RESULTS: Of 366 included patients, 171 (47%) underwent TAVR via a TA approach. AKI occurrence in this group was significantly higher compared to the TF group (38% vs. 18%, p < .01). The TA approach remained significantly associated with increased risk of AKI after logistic regression (OR 3.20; CI 1.68-4.36) and propensity score adjustment: OR 2.83 (CI 1.66-4.80) for stratification and 3.82 (CI 2.04-7.44) for matching. Nonetheless, there was no statistically significant difference among the TA and TF groups with respect to major adverse kidney events (MAKE) or estimated glomerular filtration rate (eGFR) at six months post-procedure. CONCLUSION: In a cohort of patients undergoing TAVR for aortic stenosis, a TA approach significantly increases the AKI risk compared with a TF approach. However, the TAVR approach did not affect severe renal outcomes or long-term renal function.
Thongprayoon et al. (Fri,) conducted a cohort in aortic stenosis (n=366). Transapical (TA) approach vs. Transfemoral (TF) approach was evaluated on post-procedural acute kidney injury (AKI) (OR 3.82, 95% CI 2.04-7.44, p=< .01). Transapical TAVR significantly increased the risk of acute kidney injury compared with a transfemoral approach (38% vs. 18%, p < 0.01; matched OR 3.82, 95% CI 2.04-7.44).