Siddiqui Waqas Javed, Alvarez Chikezie, Aslam Muhammad, Bakar Abu, Khan Mohammad Harisullah, Aslam Aysha, Hanif Muhammad Owais, Hasni Syed Farhan, Ranganna Karthik, Eisen Howard, Aggarwal Sandeep
Drexel University College of Medicine, Philadelphia, Pennsylvania; Hahnemann University Hospital, Philadelphia, Pennsylvania.
Seton Hall University, St. Francis Medical Center, Trenton, New Jersey.
Am J Cardiol. 2018 Aug 1;122(3):468-476. doi: 10.1016/j.amjcard.2018.04.030. Epub 2018 May 3.
Acute kidney injury (AKI) is commonly associated with aortic valve replacement. Surgical aortic valve replacement (SAVR) is a known risk factor for AKI but little is known about the short- and long-term effects of transcatheter aortic valve implantation (TAVI). The purpose of our analysis is to identify the short- and long-term effect of TAVI on renal outcomes. We searched Medline and PUBMED from January 1, 2000 to November 6, 2017 for randomized control trials (RCTs) comparing TAVI to SAVR in patients with severe aortic stenosis. Three hundred sixty-nine trials were identified, 6 RCTs were included in our analysis. RevMan version 5.3 was used for statistical analysis. Heterogeneity is calculated using I statistics. Primary outcomes were AKI within 30 days and 1 year of TAVI, and requirement for renal replacement therapy. We included 5,536 patients (2,796 in TAVI and 2,740 in SAVR arm) from 6 RCTs. Baseline characteristics were similar. There was reduced incidence of AKI at 30 days of TAVI compared with SAVR, 57 versus 133 (odds ratio [OR] 0.40, confidence interval [CI] 0.28 to 0.56, p <0.00001, I = 7%) with no difference at 1 year (OR 0.65, CI 0.32 to 1.32, p = 0.23, I = 76%) and need for renal replacement therapy OR 0.95, CI 0.50 to 1.80, p = 0.87, I = 0%). Permanent pacemaker was more frequent in the TAVI arm compared with SAVR arm, 379 versus 110, (OR 3.75, CI 1.67 to 8.42, p = 0.001, I = 89%). In conclusion, TAVI is associated with a reduction in AKIs at 30 days despite the exposure to contrast and higher incidence of new permanent pacemaker placement.
急性肾损伤（AKI）通常与主动脉瓣置换术相关。外科主动脉瓣置换术（SAVR）是已知的AKI风险因素，但关于经导管主动脉瓣植入术（TAVI）的短期和长期影响知之甚少。我们分析的目的是确定TAVI对肾脏结局的短期和长期影响。我们检索了2000年1月1日至2017年11月6日期间的Medline和PUBMED，以查找比较TAVI与SAVR治疗严重主动脉瓣狭窄患者的随机对照试验（RCT）。共识别出369项试验，我们的分析纳入了6项RCT。使用RevMan 5.3版进行统计分析。异质性使用I统计量计算。主要结局为TAVI术后30天和1年内的AKI以及肾脏替代治疗的需求。我们纳入了6项RCT中的5536例患者（TAVI组2796例，SAVR组2740例）。基线特征相似。与SAVR相比，TAVI术后30天AKI的发生率降低，分别为57例和133例（优势比[OR]0.40，置信区间[CI]0.28至0.56，p<0.00001，I=7%），1年时无差异（OR 0.65，CI 0.32至1.32，p=0.23，I=76%），肾脏替代治疗需求的OR为0.95，CI 0.50至1.80，p=0.87，I=0%）。与SAVR组相比，TAVI组永久性起搏器植入更为频繁，分别为379例和110例（OR 3.75，CI 1.67至8.42，p=0.001，I=89%）。总之，尽管TAVI暴露于造影剂且新永久性起搏器植入发生率较高，但TAVI与30天时AKI的减少相关。
