Department of Nephrology and Transplantation, Royal Perth Hospital Interventional Cardiology & High Risk Aortic Stenosis State Service WA, Royal Perth Hospital, Perth, Western Australia, Australia.
Nephrology (Carlton). 2012 Jul;17(5):445-51. doi: 10.1111/j.1440-1797.2012.01593.x.
Transcatheter aortic valve implantation (TAVI) poses a significant risk of acute kidney injury (AKI). Little is known of the impact of TAVI and AKI on long-term kidney function and health cost. We explored the predictive factors and prognostic implications of AKI following TAVI.
Single-centre retrospective analysis of 52 elderly patients undergoing TAVI was conducted. The primary endpoint was renal outcome which included the incidence of AKI and 12-month renal function after TAVI. Secondary endpoints were mortality, the length of hospital stay (LOS) and cost.
AKI occurred in 15/52 (28.8%) patients (mean age 84 ± 6) and three patients (6%) required dialysis. Patients with AKI (AKI+) had greater comorbidity (diabetes and cerebrovascular disease) and a trend towards reduced estimated glomerular filtration rate (eGFR) at baseline compared with those without AKI (56.6 vs AKI-: 65.7 mL/min per 1.73 m(2) , P = 0.07). Following TAVI, AKI- patients experienced an immediate improvement in eGFR, which remained significantly higher at all time points compared with AKI+ patients (70.4 vs 46.9 at 6 months and 73.7 vs 53.0 at 12 months, P < 0.001). Cumulative mortality for AKI+versus AKI- group was 26.7% and 2.7% (P = 0.006). LOS doubled (P < 0.001) and average hospitalization cost per patient was 1.5 times higher in the AKI+ group (P < 0.001). Independent predictors of AKI were peri-procedural blood transfusion (OR: 2.4, 95% CI: 2.0-3.1), trans-apical approach (OR: 9.3, 95% CI: 4.3-23.7) and hypertension (OR: 6.4, 95% CI: 2.9-17.3).
AKI developed in 28.8% of patients after TAVI and was associated with procedural technique and transfusion requirement, and an increased LOS and mortality. However, most patients achieved a significant and sustained improvement in eGFR.
经导管主动脉瓣植入术（TAVI）会导致急性肾损伤（AKI）的风险显著增加。对于 TAVI 和 AKI 对长期肾功能和健康成本的影响，我们知之甚少。我们探讨了 TAVI 后 AKI 的预测因素和预后意义。
对 52 名接受 TAVI 的老年患者进行了单中心回顾性分析。主要终点是肾脏结局，包括 TAVI 后 AKI 的发生率和 12 个月时的肾功能。次要终点是死亡率、住院时间（LOS）和费用。
52 名患者中有 15 名（28.8%）发生 AKI（平均年龄 84±6 岁），3 名患者（6%）需要透析。与无 AKI 患者相比，发生 AKI（AKI+）的患者合并症更多（糖尿病和脑血管疾病），并且基线时估算肾小球滤过率（eGFR）有降低趋势（56.6 比 AKI-：65.7 ml/min/1.73m²，P=0.07）。TAVI 后，AKI-患者的 eGFR 立即改善，并且在所有时间点均明显高于 AKI+患者（6 个月时为 70.4 比 46.9，12 个月时为 73.7 比 53.0，P<0.001）。AKI+组与 AKI-组的累积死亡率分别为 26.7%和 2.7%（P=0.006）。AKI+组的 LOS 增加了一倍（P<0.001），每位患者的平均住院费用增加了 1.5 倍（P<0.001）。AKI 的独立预测因素是围手术期输血（OR：2.4，95%CI：2.0-3.1）、经心尖途径（OR：9.3，95%CI：4.3-23.7）和高血压（OR：6.4，95%CI：2.9-17.3）。
TAVI 后 28.8%的患者发生 AKI，与手术技术和输血需求相关，并且与 LOS 延长和死亡率增加相关。然而，大多数患者的 eGFR 显著且持续改善。
