Highly calcified Suprarenal aortic atheroma associated with AKI after transcatheter aortic valve replacement

Acute kidney injury (AKI) may complicate transcatheter aortic valve replacement (TAVR). This could be related to atheroembolization associated with catheter manipulation in the supra-renal (SR) aorta.

Researchers in the present study determined the impact of SR aortic atheroma burden (SR-AAB) and composition, as well as of the aortic valve calcium score (AV-CS), measured at pre-operative multislice computed tomography (PO-MSCT), on AKI-TAVR. They subcategorized calcified plaque into three strata: low- (351–700 HU), mid- (701–1000 HU), and high‑calcium (>1000 HU, termed 1 K-plaque).

The study results could be summarised as follows:

• Researchers included 222 patients with a mean age of 83.3 ± 5.7 years. (TAVR patients).
• 42.8% were males.
• 67/222 patients constituting 30.2%, had AKI-TAVR.
• Patients developing AKI-TAVR had higher Absolute SR-AAB and %SR-AAB.
• Patients who developed AKI-TAVR had higher mid‑calcium and 1 K plaque. They had no difference in AV-CS (p = 0.691).
• There was an increased risk of AKI when the %SR-AAB is >15.0% and the %SR-calcified plaque is >7.0%.
• %SR-AAB [OR 1.12] and %SR-calcified plaque [OR 5.60] had associated with AKI-TAVR.

We identified %SR-AAB >15.0% and %SR-calcified plaque >7.0% as optimal thresholds for predicting increased risk of AKI-TAVR from 3-knots spline analyses.

The study highlighted the usefulness of 3-dimensional multislice computed tomography in pre-TAVR evaluation.

The researchers in this study found higher supra-renal aortic atheroma burden (SR-AAB) and calcified plaque in AKI patients.

Further reading:

Supra-renal aortic atheroma extent and composition predict acute kidney injury after transcatheter aortic valve replacement: A three-dimensional computed tomography study.

DOI:https://doi.org/10.1016/j.ijcard.2023.03.053