Background and Goal of Study: Acute kidney injury (AKI), a complication after transcatheter aortic valve implantation (TAVI), has been found to be independently associated with short-term and long-term mortality. Arterial stiffness is reported to be a strong predictor of cardiovascular events and renal dysfunction. As arterial stiffness increases, a pulse wave is transmitted and reflected more rapidly, resulting in higher pulse pressure (PP). PP can be therefore used as an index of arterial stiffness. In this study, we aimed to identify the predictors of AKI after TAVI and clarify the association between PP and AKI after TAVI.
Materials and Methods: This was a retrospective observational study approved by the Institutional Review Board. We investigated consecutive patients undergoing TAVI for aortic stenosis in our institution between October 2013 and August 2017. All procedures were performed under general anesthesia. We used perioperative indirect peripheral brachial PP (pPP) at rest as an index of arterial stiffness. The exclusion criteria were patients in whom pPP was not measured, those with atrial fibrillation, those with severe aortic regurgitation, and those requiring cardiopulmonary bypass as a rescue device or reoperation because of bleeding complications. AKI was defined according to the Valve Academic Research Consortium (VARC)-2 criteria. Univariate and multivariate logistic regression analyses were performed to identify the independent preoperative and intraoperative predictors of AKI. Date are presented as mean ± standard deviation (SD). A two-sided p value of <0.05 was considered statistically significant.
Results: Seventy-four patients were included in this study (mean age, 85.6±5 years; men, 32.4%; transapical [TA] approach, 36.5%). AKI after TAVI occurred in 44.6% (33 patients). In a multivariate analysis, the incidence of AKI was independently associated with pPP (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04-1.13; p<0.001) and the TA approach (OR, 9.39; 95% CI, 2.28-38.7; p<0.01, as compared with the transfemoral approach).
Conclusion: High pPP and the TA approach can be predictors of AKI after TAVI. 

06 / Association between pulse pressure and acute kidney injury after transcatheter aortic valve implantation