Wang Jiayang, Yu Wenyuan, Zhou Ye, Yang Yong, Li Chenglong, Liu Nan, Hou Xiaotong, Wang Longfei
Department of Cardiac Surgery, Beijing An Zhen Hospital Capital Medical University, Beijing, China; Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing, China.
Department of Cardiac Surgery, Beijing An Zhen Hospital Capital Medical University, Beijing, China.
J Cardiothorac Vasc Anesth. 2017 Jun;31(3):816-826. doi: 10.1053/j.jvca.2016.12.021. Epub 2016 Dec 21.
This study aimed to examine the risk factors for transcatheter aortic valve implantation (TAVI)-associated acute kidney injury (AKI) according to the AKI definition from the Valve Academic Research Consortium-2 (VARC-2).
A meta-analysis.
A total of 661 patients with post-TAVI AKI according to the VARC-2 definition and 2,012 controls were included in the meta-analysis.
Patients undergoing TAVI were included in this meta-analysis.
Multiple electronic databases were searched using predefined criteria. The diagnosis of AKI was based on the VARC-2 classification. The authors found that preoperative New York Heart Association class IV (odds ratio [OR], 7.77; 95% confidence interval [CI], 3.81-15.85), previous chronic renal disease (CKD) (OR, 2.81; 95% CI, 1.96-4.03), and requirement for transfusion (OR, 2.03; 95% CI, 1.59-2.59) were associated significantly with an increased risk for post-TAVI AKI. Furthermore, previous peripheral vascular disease (PVD), hypertension, atrial fibrillation, congestive heart failure, diabetes mellitus, and stroke were also risk factors for TAVI-associated AKI. Additionally, transfemoral access significantly correlated with a reduced risk for post-TAVI AKI (OR, 0.43; 95% CI, 0.33-0.57). The potential confounders, including Society of Thoracic Surgeons Score, the logistic European System for Cardiac Operative Risk Evaluation, aortic valve area, mean pressure gradient, left ventricular ejection fraction, age, body mass index, contrast volume, and valve type, had no impact on the association between the risk factors and post-TAVI AKI. Subgroup analysis of the eligible studies presenting multivariate logistic regression analysis on the independent risk factors for post-TAVI AKI revealed that previous CKD, previous PVD, and transapical access were independent risk factors for TAVI-associated AKI.
The current meta-analysis suggested that previous CKD, previous PVD, and transapical access may be independent risk factors for TAVI-associated AKI.
本研究旨在根据瓣膜学术研究联盟-2（VARC-2）的急性肾损伤（AKI）定义，探讨经导管主动脉瓣植入术（TAVI）相关急性肾损伤的危险因素。
一项荟萃分析。
共有661例根据VARC-2定义的TAVI术后AKI患者和2012例对照纳入荟萃分析。
接受TAVI的患者纳入本荟萃分析。
使用预定义标准检索多个电子数据库。AKI的诊断基于VARC-2分类。作者发现，术前纽约心脏协会IV级（比值比[OR]，7.77；95%置信区间[CI]，3.81-15.85）、既往慢性肾脏病（CKD）（OR，2.81；95%CI，1.96-4.03）以及输血需求（OR，2.03；95%CI，1.59-2.59）与TAVI术后AKI风险增加显著相关。此外，既往外周血管疾病（PVD）、高血压、心房颤动、充血性心力衰竭、糖尿病和中风也是TAVI相关AKI的危险因素。此外，经股动脉入路与TAVI术后AKI风险降低显著相关（OR，0.43；95%CI，0.33-0.57）。潜在的混杂因素，包括胸外科医师协会评分、欧洲心脏手术风险评估逻辑系统、主动脉瓣面积、平均压力阶差、左心室射血分数、年龄、体重指数、造影剂用量和瓣膜类型，对危险因素与TAVI术后AKI之间的关联没有影响。对 eligible 研究进行的亚组分析显示，既往CKD、既往PVD和经心尖入路是TAVI相关AKI的独立危险因素。
当前的荟萃分析表明，既往CKD、既往PVD和经心尖入路可能是TAVI相关AKI的独立危险因素。
