{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:07:52Z","timestamp":1791994072501,"version":"4.4.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,10,4]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. However, it is controversial whether AKI affects prognosis per se, being linked to baseline chronic kidney disease (CKD) and bleeding complications. The aim of this study was to disentangle, applying mediation analysis, the association between AKI and clinical outcome, considering CKD and bleedings.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Consecutive patients undergoing TAVR were prospectively enrolled at 5 high\u2010volume centers in Italy. AKI was defined according to Valve Academic Research Consortium\u20103 consensus, whereas bleeding with Bleeding Academic Research Consortium. Primary outcome was all\u2010cause mortality after 1\u2010year follow\u2010up. Among 2621 patients undergoing TAVR, AKI occurrence was associated with 1\u2010year mortality. This association of AKI with the primary end points remained significant after adjusting for baseline risk estimators, either Society of Thoracic Surgeons score (hazard ratio [HR], 2.78 [95% CI, 1.95\u20133.80],\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) or EuroSCORE\u2010II (HR, 1.85 [95% CI, 1.35\u20132.56],\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Both AKI and CKD significantly and independently affected primary outcome (HR, 3.06 [95% CI, 2.01\u20134.64],\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001 and HR, 1.82 [95% CI 1.27\u20132.65],\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01, respectively). The estimated proportion of the total effect of CKD mediated via AKI was, on average, 15%, 95% CI, 4%\u201329%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001. The significant effect of Bleeding Academic Research Consortium 2\u20135 bleedings on the primary outcome was not mediated by AKI.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">AKI occurs in 1 out of 6 patients and significantly mediates one fifth of the effect of baseline CKD on all\u2010cause mortality after TAVR. Our analysis supports a systematic effort to prevent AKI during TAVR, which may potentially translate into improved patients' 1\u2010year survival.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.024589","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T09:40:43Z","timestamp":1664444443000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Acute Kidney Injury After Transcatheter Aortic Valve Replacement Mediates the Effect of Chronic Kidney Disease"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2852-061X","authenticated-orcid":false,"given":"Gabriele","family":"Crimi","sequence":"first","affiliation":[{"name":"Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8031-9761","authenticated-orcid":false,"given":"Vincenzo","family":"De Marzo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy"},{"name":"Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3554-6938","authenticated-orcid":false,"given":"Federico","family":"De Marco","sequence":"additional","affiliation":[{"name":"Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Conrotto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Citt\u00e0 della Salute e della Scienza Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Oreglia","sequence":"additional","affiliation":[{"name":"Cardiology I, \"A. De Gasperis\" Department Ospedale Niguarda Ca\u2019 Granda Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"D'Ascenzo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Citt\u00e0 della Salute e della Scienza Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4687-3686","authenticated-orcid":false,"given":"Luca","family":"Testa","sequence":"additional","affiliation":[{"name":"Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Gorla","sequence":"additional","affiliation":[{"name":"Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7363-566X","authenticated-orcid":false,"given":"Giuseppe","family":"Esposito","sequence":"additional","affiliation":[{"name":"Cardiology I, \"A. De Gasperis\" Department Ospedale Niguarda Ca\u2019 Granda Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabato","family":"Sorrentino","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical and Surgical Sciences, Catanzaro Italian Society of Cardiology (SIC) Magna Graecia University Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Spaccarotella","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical and Surgical Sciences, Catanzaro Italian Society of Cardiology (SIC) Magna Graecia University Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Soriano","sequence":"additional","affiliation":[{"name":"Cardiology I, \"A. 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