Bagur et al identified risk factors associated with acute kidney injury (AKI) following aortic valve replacement surgery (AVR). Acute renal failure following cardiac surgery is associated with worse outcomes including increased mortality. The authors are from Laval University in Quebec and the University of British Columbia in Canda.


Patient selection: Patients undergoing transcatheter AVR tended to be high risk surgical candidates unable to undergo standard surgical AVR. Many patients had some degree of chronic kidney disease.


Criteria for acute kidney injury - one or both of the following:

(1) decrease in estimated GFR by > 25% in the 48 hours following surgery

(2) ned for hemodialysis during the hospitalization


The risk of acute renal injury is greater with surgical aortic valve replacement than for transcatheter implantation. The risk of acute kidney injury was about 3 times higher (26% with standard surgery vs 9% for transcatheter AVR)..


Theoretical reasons for acute renal injury associated with transcatheter AVR:

(1) use of radiocontrast materials

(2) hypotension during the procedure

(3) atherosclerotic emboli dislodged by an intra-aortic catheter


Actual risk factors for acute renal injury associated with a transcatheter AVR:

(1) hypertension

(2) chronic obstructive pulmonary disease (COPD)

(3) peri-operative blood transfusion


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