Department of Cardiac Surgery, German Heart Centre, Munich, Germany.
Am Heart J. 2011 Apr;161(4):735-9. doi: 10.1016/j.ahj.2011.01.009.
Acute kidney injury (AKI) can occur in up to one third of patients after surgical aortic valve replacement and can be associated with increased mortality. Little data exist, however, about the incidence, predictors, and prognostic implications of AKI after transcatheter aortic valve implantation (TAVI).
The aim of this study was to examine the incidence, predictors, and prognostic implications of AKI after TAVI.
Between January 2007 and January 2010, we prospectively enrolled 234 consecutive patients who underwent TAVI with the Medtronic CoreValve System (Medtronic CoreValve, Minneapolis, Minnesota) or Edwards SAPIEN (Edwards Lifesciences, Inc, Irvine, CA) heart valve. Acute kidney injury was defined according to the risk, injury, failure, loss, end-stage criteria. Patients with preoperative end-stage renal failure requiring dialysis were excluded. Baseline characteristics and procedural-related factors were examined as predictors for AKI in a multivariable regression model.
Acute kidney injury was identified in 46 (19.6%) of 234 patients, and 24 (10.3%) of 234 patients required renal replacement therapy. The unadjusted in-hospital mortality rate was 15.2% in those patients without AKI and 7.7% in those with AKI (P = .015). Univariable logistic regression analysis identified preoperative serum creatinine, preoperative blood urea nitrogen, peripheral vascular disease, and blood transfusion to be associated with AKI. Preoperative serum creatinine level remained as the only independent predictor of AKI (OR 3.7 95%, CI 1.24-11.3, P = .019). The amount of contrast used (in milliliters) was not associated with AKI (OR 1.8 95%, CI 0.94-3.5, P = .07).
In this study, we observed that one fifth of patients developed AKI after TAVI and that AKI was associated with increased in-hospital mortality. Preoperative serum creatinine level was identified as the only predictor of AKI.
在接受主动脉瓣置换术后，多达三分之一的患者会出现急性肾损伤（AKI），并且可能与死亡率增加有关。然而，关于经导管主动脉瓣植入术（TAVI）后 AKI 的发生率、预测因素和预后意义的数据很少。
本研究旨在探讨 TAVI 后 AKI 的发生率、预测因素和预后意义。
2007 年 1 月至 2010 年 1 月，我们前瞻性地纳入了 234 例连续接受经导管主动脉瓣置换术的患者，使用美敦力核心瓣膜系统（美敦力核心瓣膜，明尼苏达州明尼阿波利斯）或爱德华兹 SAPIEN（爱德华兹生命科学公司，加利福尼亚州欧文）心脏瓣膜。急性肾损伤根据风险、损伤、衰竭、丧失、终末期标准定义。排除术前终末期肾衰竭需要透析的患者。多变量回归模型检查了基线特征和与手术相关的因素作为 AKI 的预测因素。
234 例患者中 46 例（19.6%）诊断为 AKI，234 例患者中有 24 例（10.3%）需要肾脏替代治疗。无 AKI 患者的院内死亡率为 15.2%，AKI 患者为 7.7%（P=0.015）。单变量逻辑回归分析发现术前血清肌酐、术前血尿素氮、外周血管疾病和输血与 AKI 相关。术前血清肌酐水平仍然是 AKI 的唯一独立预测因素（OR 3.7，95%CI 1.24-11.3，P=0.019）。使用的造影剂量（毫升）与 AKI 无关（OR 1.8，95%CI 0.94-3.5，P=0.07）。
在这项研究中，我们观察到五分之一的患者在接受 TAVI 后出现 AKI，并且 AKI 与住院死亡率增加有关。术前血清肌酐水平被确定为 AKI 的唯一预测因素。
