Acute Kidney Injury After Transcatheter Aortic Valve Implantation: An Early-Concentrated Mortality Burden

Objective: Acute kidney injury (AKI) is a recognized complication of transcatheter aortic valve implantation (TAVI), but data based on the updated Valve Academic Research Consortium-3 (VARC-3) definition remain limited. We aimed to determine the incidence of VARC-3-defined AKI, identify factors associated with its development, and characterize its prognostic significance in patients undergoing TAVI.
Method: We retrospectively analyzed 106 consecutive patients who underwent TAVI at a single center and had paired baseline and early postprocedural creatinine measurements. AKI was defined and staged according to VARC-3 criteria. Factors associated with AKI were assessed using univariable logistic regression; survival was analyzed using Kaplan-Meier, Cox regression, and landmark analyses.
Results: AKI developed in 16 of 106 patients (15.1%). Lower baseline left ventricular ejection fraction (LVEF) and higher procedural contrast volume were the only variables significantly associated with AKI in univariable analysis (both p=0.007). Patients with AKI had markedly reduced survival (log-rank p=0.012). Landmark analysis demonstrated that excess mortality was concentrated within the first six months (hazard ratio [HR] 13.23, 95% confidence interval [CI] 3.30–52.96, p=0.0003), with no significant association thereafter.
Conclusion: VARC-3-defined AKI occurred in approximately one in seven TAVI patients and was associated with substantially impaired survival. The excess mortality associated with AKI was concentrated predominantly within the first six months; among patients with AKI who died, the majority of deaths were classified as cardiovascular. These findings characterize the temporal and cause-specific pattern of AKI-associated mortality and should be interpreted as observational associations rather than evidence of a causal effect of AKI.

Keywords: Acute kidney injury, aortic valve stenosis, left ventricular ejection fraction, mortality, transcatheter aortic valve implantation.