Procedural and Device Neutrality of Post-TAVI Renal Outcomes: A Multivariable Analysis of Valve Type, Size, and Anatomy

<b>Background:</b> Renal dysfunction remains a frequent complication after transcatheter aortic valve implantation (TAVI). Although contrast exposure and baseline renal impairment are established risk factors, the influence of structural valve characteristics, including valve diameter and prosthesis platform, on early renal outcomes is not well defined. This study evaluated whether valve size and valve platform independently affect early post-procedural renal function. <b>Methods:</b> This retrospective cohort study included 410 consecutive patients undergoing TAVI between 2018 and 2021 with complete pre- and post-procedural renal biomarker data. Of these, 371 patients with complete covariate data were analyzed in multivariable models. Serum creatinine and estimated glomerular filtration rate (eGFR) were assessed within 72 h before and after TAVI. Renal function change was calculated as absolute differences. Acute kidney injury (AKI) was defined according to KDIGO criteria. Correlation analyses and multivariable linear and logistic regression models were performed. <b>Results:</b> Median valve diameter was 26 mm (IQR 26-29). Renal function remained largely stable, with a median creatinine change of -0.06 mg/dL and median eGFR change of +4.0 mL/min/1.73 m². Valve diameter was not associated with creatinine change (ρ = -0.047, <i>p</i> = 0.330) or eGFR change (ρ = 0.053, <i>p</i> = 0.278). KDIGO-defined AKI occurred in 56 patients (13.7%) and did not differ by valve platform (<i>p</i> = 0.719) or diameter tertiles (<i>p</i> = 0.204). <b>Conclusions:</b> Valve diameter and platform were not independently associated with early renal outcomes after TAVI. Baseline renal function and contrast exposure were the principal determinants of post-procedural renal trajectory.