Columbia University Medical Center/New York-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA.
Am J Cardiol. 2013 Jan 1;111(1):100-5. doi: 10.1016/j.amjcard.2012.08.057. Epub 2012 Oct 4.
Acute kidney injury (AKI) is associated with a poor prognosis after transcatheter aortic valve replacement (TAVR). A paucity of data exists regarding the incidence and effect of AKI after TAVR using the new recommended Valve Academic Research Consortium criteria. At Columbia University Medical Center, 218 TAVR procedures (64.2% transfemoral, 35.8% transapical) were performed from 2008 to July 2011. The creatinine level was evaluated daily until discharge. Using the Valve Academic Research Consortium definitions, the 30-day and 1-year outcomes were compared between patients with significant AKI (AKI stage 2 or 3) and those without significant AKI (AKI stage 0 or 1). Significant AKI occurred in 18 patients (8.3%). Of these 18 patients, 10 (55.6%) had AKI stage 3 and 9 (50%) required dialysis. AKI was associated with a lower baseline mean transvalvular gradient (37.6 ± 11.4 vs 45.6 ± 14.8 mm Hg for no AKI, p = 0.03). After TAVR, the AKI group had a greater hemoglobin decrease (3.6 ± 2.0 vs 2.4 ± 1.3 g/dl, p = 0.01), greater white blood cell elevation at 72 hours (21.09 ± 12.99 vs 13.18 ± 4.82 × 10(3)/μl, p = 0.001), a more severe platelet decrease (118 ± 40 vs 75 ± 43 × 10(3)/μl, p <0.0001), and longer hospitalization (10.7 ± 6.4 vs 7.7 ± 8.5 days, p <0.001). One stroke (5.6%) occurred in the AKI group compared with 3 (1.5%) in the group without AKI (p = 0.29). The 30-day and 1-year rates of death were significantly greater in the AKI group than in the no-AKI group (44.4% vs 3.0%, hazard ratio 18.1, 95% confidence interval 6.25 to 52.20, p <0.0001; and 55.6% vs 16.0%, hazard ratio 6.32, 95% confidence interval 3.06 to 13.10, p <0.0001, respectively). Periprocedural life-threatening bleeding was the strongest predictor of AKI after TAVR. In conclusion, the occurrence of AKI, as defined by the Valve Academic Research Consortium criteria, is associated with periprocedural complications and a poor prognosis after TAVR.
急性肾损伤（AKI）与经导管主动脉瓣置换术（TAVR）后的预后不良相关。使用新推荐的 Valve Academic Research Consortium 标准，关于 TAVR 后 AKI 的发生率和影响的数据很少。在哥伦比亚大学医学中心，2008 年至 2011 年 7 月进行了 218 例 TAVR 手术（64.2%经股动脉，35.8%经心尖）。在出院前每天评估肌酐水平。使用 Valve Academic Research Consortium 定义，比较了有明显 AKI（AKI 第 2 或 3 期）和无明显 AKI（AKI 第 0 或 1 期）患者的 30 天和 1 年结局。18 例患者（8.3%）发生明显 AKI。在这 18 名患者中，10 名（55.6%）患者 AKI 分期 3 期，9 名（50%）需要透析。AKI 与较低的基线平均跨瓣梯度相关（无 AKI 时为 37.6 ± 11.4 毫米汞柱，AKI 时为 45.6 ± 14.8 毫米汞柱，p = 0.03）。TAVR 后，AKI 组的血红蛋白下降更大（3.6 ± 2.0 vs 2.4 ± 1.3 g/dl，p = 0.01），72 小时白细胞升高更大（21.09 ± 12.99 vs 13.18 ± 4.82 × 10(3)/μl，p = 0.001），血小板下降更严重（118 ± 40 vs 75 ± 43 × 10(3)/μl，p <0.0001），住院时间更长（10.7 ± 6.4 vs 7.7 ± 8.5 天，p <0.001）。AKI 组发生 1 例中风（5.6%），无 AKI 组发生 3 例（1.5%）（p = 0.29）。AKI 组 30 天和 1 年死亡率明显高于无 AKI 组（44.4% vs 3.0%，风险比 18.1，95%置信区间 6.25 至 52.20，p <0.0001；和 55.6% vs 16.0%，风险比 6.32，95%置信区间 3.06 至 13.10，p <0.0001）。围手术期危及生命的出血是 TAVR 后 AKI 的最强预测因素。总之，使用 Valve Academic Research Consortium 标准定义的 AKI 的发生与 TAVR 后围手术期并发症和不良预后相关。
