Acute Kidney Injury Following Transcatheter Aortic Valve Implantation - A Contemporary Perspective of Incidence, Predictors, and Outcomes

Background Acute kidney injury (AKI) is a known complication following transcatheter aortic valve implantation (TAVI), associated with increased morbidity and mortality. Most of this data relates to higher-risk patients with early-generation TAVI valves. With TAVI now established as a safe and cost-effective procedure for low-risk patients, there is a distinct need for updated analysis. We aimed to assess the incidence, predictors, and outcomes of AKI in a contemporary cohort of TAVI patients, concurrently examining the role of temporal evolution on AKI. Method A total of 2,564 patients undergoing TAVI from 2008 - 2023 included in the Alfred-Cabrini-Epworth (ACE) TAVI Registry were analysed. Patients were divided into AKI and no AKI groups. Outcomes were reported according to the Valve Academic Research Consortium -3 (VARC-3) criteria. Results Of 2,564 patients, median age 83 (78 - 87) years, 57.4% men and a median Society of Thoracic Surgeons score of 3.6 (2.4 - 5.5), 163 (6.4%) patients developed AKI with incidence falling from 9.7% between 2008 - 2014 to 6% between 2015 - 2023 (p=0.022). On multivariable analysis, independent predictors of AKI were male sex (adjusted odds ratio [aOR] 1.89, p=0.005), congestive cardiac failure (aOR 1.52, p=0.048), estimated glomerular fi ltration rate 30 - 59 (aOR: 2.79, p < 0.001), estimated glomerular fi ltration rate < 30 (aOR 8.65, p < 0.001), non -femoral access (aOR 5.35, p < 0.001), contrast volume (aOR 1.01, p < 0.001), self-expanding valve (aOR 1.60, p=0.045), and bleeding (aOR 2.88, p=0.005). Acute kidney injury was an independent predictor of 30-day (aOR: 6.07, p < 0.001) and 12-month (aOR: 3.01, p=0.002) mortality, an association that remained consistent when excluding TAVIs performed prior to 2015. Conclusions Acute kidney injury remains a relatively common complication of TAVI, associated with significant morbidity and mortality even in less comorbid, contemporary practice patients.