ABSTRACT
Acute kidney recovery (AKR) is a recently described phenomenon observed after transcatheter aortic valve replacement (TAVR) and is more frequent than acute kidney injury (AKI). To determine the incidence and predictors of AKR between surgical aortic valve replacement (SAVR) and TAVR, we examined patients with chronic kidney disease and severe aortic stenosis who underwent SAVR or TAVR procedure between 2007 and 2017; excluding age <65 or >90, dialysis, endocarditis, non-aortic valve stenosis, or patients died within 48-hours postprocedure. AKR was defined as an increase of estimated glomerular filtration rate (eGFR) >25% and AKI as decrease in eGFR >25% at discharge. Stroke, mortality, major bleeding, transfusion, and length of stay were examined. Multivariate logistic regression analysis was used to examine predictors of AKR. There were 750 transcatheter and 1,062 surgical patients and 319 pairs after propensity matching. AKR was observed in 26% TAVR versus 23.2% SAVR, pâ¯=â¯0.062. Highest recovery was in patients with eGFR <30 for both TAVR (33.7%) and SAVR (34.5%) patients. Independent predictors of AKR were ejection fraction <50% (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.02 to 2.71, pâ¯=â¯0.042), female gender (OR 1.66, 95% CI 1.1 to 2.5, pâ¯=â¯0.015), and obesity (OR 1.5, 95% CI 1.04-2.3, pâ¯=â¯0.032). Diabetes was a negative predictor of AKR (OR 0.55, 95% CI 0.36 to 0.84, pâ¯=â¯0.005). AKR was associated with improved secondary clinical outcomes compared with AKI. In conclusion, AKR is a generalizable phenomenon occurring frequently and similarly among transcatheter or surgical aortic valve patients. Diabetes is a negative predictor of AKR, possibly indicative of less reversible kidney disease.
Subject(s)
Aortic Valve Stenosis/surgery , Glomerular Filtration Rate , Heart Valve Prosthesis Implantation , Hospital Mortality , Recovery of Function , Renal Insufficiency, Chronic/metabolism , Transcatheter Aortic Valve Replacement , Acute Kidney Injury/epidemiology , Aged , Aged, 80 and over , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/physiopathology , Blood Transfusion/statistics & numerical data , Comorbidity , Diabetes Mellitus/epidemiology , Female , Humans , Length of Stay/statistics & numerical data , Logistic Models , Male , Middle Aged , Multivariate Analysis , Obesity/epidemiology , Postoperative Hemorrhage/epidemiology , Renal Insufficiency, Chronic/epidemiology , Severity of Illness Index , Sex Factors , Stroke/epidemiology , Stroke Volume , Treatment OutcomeABSTRACT
Although there are multiple etiologies of a right atrial thrombus, the presence of a central venous catheter increases the risk for its development. Once diagnosed, an assessment of patient-specific factors will aid in dictating the appropriate management strategy. In cases of chronic disease or adherent thrombotic masses, thrombolytic therapy might not result in complete resolution of the clot burden and could lead to a devastating embolic event. Accordingly, we present a case of a right atrial thrombus not amenable to medical therapy that was removed only after concomitant utilization of an AngioVac Aspiration System (Vortex Medical, Norwell, MA) and percutaneous snare catheterization.
