Predictive Value of the Venous Excess Ultrasound Score for Acute Kidney Injury After Transcatheter Aortic Valve Replacement: A Retrospective Cohort Study.

OBJECTIVES: Acute kidney injury (AKI) is a relevant complication after transcatheter aortic valve replacement (TAVR). Venous congestion is recognized as a contributor to perioperative organ dysfunction. The Venous Excess Ultrasound Score (VExUS) provides a noninvasive assessment of systemic venous congestion. This study hypothesized that a higher pre- or postprocedural VExUS is associated with an increased risk of AKI following TAVR. DESIGN: Retrospective register study. SETTING: Two cardiovascular centers performing transcatheter aortic valve replacement. PARTICIPANTS: A total of 101 patients were included. INTERVENTIONS: Periprocedural point-of-care ultrasound examinations were performed to assess venous congestion using the VExUS before and 6 hours after TAVR. MEASUREMENTS AND MAIN RESULTS: In total, 101 patients with aortic stenosis undergoing TAVR underwent periprocedural point-of-care ultrasound to assess systemic venous congestion using the VExUS before and 6 hours after the procedure. Patients were stratified according to the presence of venous congestion (VExUS ≥1). The primary endpoint was the occurrence of AKI within 7 days after TAVR or before hospital discharge, defined according to Kidney Disease: Improving Global Outcomes criteria. The median age was 84 years (interquartile range, 80-87), 47% of patients were female, and 18% developed AKI after TAVR. A VExUS grade ≥1 was observed in 73% of patients preprocedurally and in 54% at 6 hours postprocedure (p < 0.002). Receiver operating characteristic analysis demonstrated modest discrimination for preprocedural VExUS (area under the curve [AUC], 0.62; 95% CI, 0.49-0.75) and excellent discrimination for postprocedural VExUS (AUC, 0.97; 95% CI, 0.95-1.00). A VExUS grade ≥2 was strongly associated with AKI after TAVR, with a sensitivity of 100% and a specificity of 88% (p < 0.0001). CONCLUSIONS: Venous congestion appears to contribute to AKI in patients undergoing TAVR. The VExUS may serve as a noninvasive tool for early risk stratification of AKI, supporting a potential role of venous congestion in its pathophysiology.