Dr. Wisit Cheungpasitporn (WC), from the Mayo Clinic in Rochester, Minnesota, discusses his abstract for the National Kidney Foundation’s 2016 Spring Clinical Meetings (SCM16), Acute Kidney Injury After Transfemoral Versus Transapical Approach for Transcatheter Aortic Valve Replacement, with Dr. Kenar Jhaveri, AJKD Blog Editor.
AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2015 Spring Meetings?
WC: Transcatheter aortic valve replacement (TAVR) has now emerged as a viable treatment option for high-risk patients with severe aortic stenosis who are not suitable candidates for surgical aortic valve replacement. Transfemoral and transapical access approaches are the most commonly used approaches for TAVR. Data from several registries have previously shown more acute kidney injury (AKI) in patients undergoing transapical approach than transfemoral. However, patients selected for transapical approach usually have higher comorbidities, especially peripheral vascular atherosclerotic diseases. Thus, we conducted a propensity-matched study to compare the incidence of AKI following TAVR and other renal outcomes in patients undergoing a transapical and transfemoral approaches for TAVR. We found that a transapical approach significantly increased the risk of AKI compared to a transfemoral approach (38% vs. 18%, respectively; P < 0.01), with an overall 3.82-fold increase in the risk of AKI. However, there was no significant difference between the transapical and transfemoral group in severe AKI requiring dialysis or in-hospital mortality or 6-month mortality after the procedure.
AJKDblog: Why do you think the transapical approach presents more risk to the kidney compared to the transfemoral approach for TAVRs?
WC: It is possible that the instrumentation of the aorta during the transapical approach may result in the dislodgement of calcium plaques and cholesterol crystal emboli, leading to AKI. In addition, the transapical approach is mostly performed under general anesthesia, while the transfemoral approach can be performed under moderate sedation and local anesthetics. General anesthesia may contribute to higher risk of renal hypoperfusion.
AJKDblog: Where do you and your group go from here?
WC: Since the success of TAVR depends on careful attention to detail and prompt management of complications and understanding the risk factors for AKI after TAVR, our group has continued to work on studies to improve patient selection, TAVR technique, and preventive measures to improve patients’ outcomes.
All Spring Clinical Meeting abstracts are available in the May issue of AJKD.