Glaser Natalie, Jackson Veronica, Holzmann Martin J, Franco-Cereceda Anders, Sartipy Ulrik
Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Am Heart Assoc. 2016 Dec 17;5(12):e004287. doi: 10.1161/JAHA.116.004287.
The influence of moderately reduced kidney function on late survival after surgical aortic valve replacement (AVR) is unknown. We analyzed survival after AVR in patients with moderately reduced kidney function.
All patients who underwent primary AVR in Sweden 1997-2013 were identified from the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register. Patients were categorized according to estimated glomerular filtration rate (eGFR). Of 13 102 patients, 9836 (75%) had normal kidney function (eGFR >60 mL/min per 1.73 m) and 3266 (25%) had moderately reduced kidney function (eGFR 30-60 mL/min per 1.73 m). Mean follow-up time was 6.2 years. Mortality was higher in patients with moderately reduced kidney function; 5-, 10-, and 15-year survival was 76%, 48%, and 25% versus 89%, 73%, and 55% (adjusted hazard ratio [HR], 1.28; 95% CI, 1.18-1.38; P<0.001). Patients with moderately reduced kidney function had a nonsignificantly higher risk of major bleeding (HR, 1.18; 95% CI, 1.00-1.39; P=0.051) and a lower risk for aortic valve reoperation (HR, 0.54; 95% CI, 0.38-0.79; P=0.001) compared to those with normal kidney function. In patients with moderately reduced kidney function, survival was similar in those who received bioprostheses compared to those who received mechanical valves (HR, 0.85; 95% CI, 0.70-1.03; P=0.094).
Moderately reduced kidney function was strongly associated with increased mortality after AVR. These results have important implications for preoperative risk stratification, and suggest that patients with eGFR 30 to 60 mL/min per 1.73 m warrant careful observation after AVR.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02276950.
肾功能中度降低对主动脉瓣置换术（AVR）后晚期生存的影响尚不清楚。我们分析了肾功能中度降低患者AVR后的生存情况。
从瑞典基于推荐疗法评估的心脏病循证护理增强与发展网络系统登记处识别出1997 - 2013年在瑞典接受初次AVR的所有患者。根据估计肾小球滤过率（eGFR）对患者进行分类。在13102例患者中，9836例（75%）肾功能正常（eGFR>60 mL/（min·1.73 m²）），3266例（25%）肾功能中度降低（eGFR 30 - 60 mL/（min·1.73 m²））。平均随访时间为6.2年。肾功能中度降低患者的死亡率更高；5年、10年和15年生存率分别为76%、48%和25%，而肾功能正常患者分别为89%、73%和55%（校正风险比[HR]为1.28；95%CI为1.18 - 1.38；P<0.001）。与肾功能正常的患者相比，肾功能中度降低的患者发生大出血的风险略高（HR为1.18；95%CI为1.00 - 1.39；P = 0.051），主动脉瓣再次手术的风险较低（HR为0.54；95%CI为0.38 - 0.79；P = 0.001）。在肾功能中度降低的患者中，接受生物瓣膜置换的患者与接受机械瓣膜置换的患者生存率相似（HR为0.85；95%CI为0.70 - 1.03；P = 0.094）。
肾功能中度降低与AVR后死亡率增加密切相关。这些结果对术前风险分层具有重要意义，并表明eGFR为30至60 mL/（min·1.73 m²）的患者在AVR后需要仔细观察。
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