Clinical effects of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis

Several observational studies have shown that postoperative acute kidney injury (AKI) may significantly worsen the prognosis of a transcatheter aortic valve implantation (TAVI). The purpose of this systematic review and meta-analysis is to evaluate the recent evidence on the impact of AKI on clinical outcomes following TAVI. A comprehensive search in PubMed, Embase and the Cochrane Library was performed for relevant studies by two independent investigators. We pooled the odds ratio (OR) from individual studies, and performed heterogeneity, quality assessment and publication bias analysis. Forty-three eligible studies comprising 544,112 patients were included. Postoperative AKI not only significantly increased the risk for short-term and long-term all-cause mortality (OR 6.25, 95% CI 5.72-6.83, P<0.00001; OR 3.49, 95% CI 2.78-4.40, P<0.00001, respectively), but also increased the risk for early myocardial infarction (OR 3.98, 95% CI 1.90-8.31, P=0.0002), major and life-threatening bleeding (OR 1.51, 95% CI 1.12-2.03, P=0.007; OR 2.35, 95% CI 1.80-3.06, P<0.00001, respectively), major vascular complications (OR 1.69, 95% CI 1.30-2.18, P<0.0001), need for blood transfusion (OR 2.15, 95% CI 1.89-2.46, P<0.00001) renal replacement therapy (OR 22.36, 95% CI 11.88-42.12, P=0.0002) and cerebrovascular accidents (OR 1.92, 95% CI 1.23-2.98, P=0.004). Acute kidney injury following TAVI is associated with increased postoperative mortality and morbidity. Future efforts are required to determine whether early prevention of post-procedural AKI after TAVI impacts upon clinical outcomes.