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Dear Editor, Huber et al in a single-center cohort study of 3646 patients who underwent inpatient vascular surgery between 2000 and 2010 at a tertiary care teaching hospital demonstrated that perioperative acute kidney injury (AKI) occurred in 1801 (49.4%) patients (1). Besides, adjusted cardiovascular mortality estimates at 10 years were 17%, 31%, 30%, and 41%, for patients with no kidney disease, for patients with AKI but without chronic kidney disease (CKD), for patients with CKD but without AKI, and for patients with AKI and CKD, respectively (1). Until very recently, in the cognate AKI-surgery literature, intraoperative hypotension (IOH) following hypotensive anesthesia or controlled hypotension in the operating room has been accepted to not pose any significant short-term and/or long-term consequences on renal function (2). Nevertheless, in the last few years there has been an increasing awareness of the impact of IOH as a formidable albeit preventable factor in the causation of postoperative AKI (3-7). AKI following aortic valve replacement (AVR) results in longer length of hospital stay, increased utilization of healthcare resources and at the same time is independently associated with both higher shortand long-term mortality (8,9). AKI complicating surgical AVR (SAVR) has been variously reported in the literature (10-13). The increasing trend towards less invasive surgical options for the management of symptomatic AVR especially in patients with multiple comorbidities has led to such innovative surgical techniques as minimally invasive AVR, and recently, transcatheter AVR (TAVR) (14-16). Very lately, Cheungpasitporn and colleagues from Mayo Clinic, Rochester, in an extensive review of the TAVR literature published in this journal, Journal of Renal Injury Prevention, noted that TAVR has now emerged as a viable treatment option for high-risk patients with severe aortic stenosis (AS) who are not suitable candidates for SAVR (17). The authors acknowledged that despite encouraging published outcomes, AKI after TAVR is common and lowers the survival of patients after TAVR (17). Factors identified to contribute to AKI following TAVR include Implication for health policy/practice/research/medical education: There is newly accumulating evidence in the surgery-acute kidney injury (AKI) literature that intraoperative hypotension (IOH) is a formidable and yet preventable causative factor in precipitating postoperative AKI. Postoperative AKI portends both increased shortand long-term morbidity and mortality, increased length of stay and higher healthcare costs. IOH is preventable. We present a case of AKI that led to the syndrome of rapid onset end stage renal disease (SORO-ESRD) in a 73-year-old diabetic hypertensive chronic kidney disease (CKD) male patient in 2012 following minimally invasive surgical aortic valve replacement. We call for more attention to be paid to IOH and to avoid too low blood pressures in the operating room. We posit that systolic blood pressure targets ≥ 90 mm Hg and/or MABP targets ≥ 60 mm Hg potentially would improve postoperative renal outcomes. Please cite this paper as: Onuigbo MAC, Agbasi N. Comment on; post-transcatheter aortic valve replacement acute kidney injury; prevention rather than cure. J Renal Inj Prev. 2017;6(2):12-15. DOI: 10.15171/jrip.2017.02 A R T I C L E I N F O