[经导管主动脉瓣置换术对重度主动脉瓣狭窄患者肾功能的影响]
[Impact of transcatheter aortic valve replacement on renal function in patients with severe aortic stenosis].
作者信息
Yang L F, Zhang X C, Zhang Y, Chen S S, Guan L H, Pan W Z, Zhou D X, Ge J B
机构信息
Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
出版信息
Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Jan 11;49(1):49-53. doi: 10.3760/cma.j.cn112148-20200308-00173.
To explore the impact of transcatheter aortic valve replacement (TAVR) on renal function in patients with severe aortic stenosis. This is a single-center retrospective study. Consecutive patients with severe aortic valve stenosis and received TAVR in Zhongshan Hospital from December 2014 to December 2019 were included. The patients were divided into four groups according to the estimate glomerular filtration rate (eGFR) measured at one day before TAVR, namely eGFR>90 ml·min·1.73m group, 60<eGFR≤90 ml·min·1.73m group, 30<eGFR≤60 ml·min·1.73m group and eGFR≤30 ml·min·1.73m group. The patients were also divided into acute renal function recovery (AKR) group, acute kidney injury (AKI) group and no change in renal function group according to renal function changes at 72 hours after TAVR. AKR was defined as eGFR increased by more than 25% of the baseline value at 72 hours after TAVR, and AKI was defined as eGFR decreased more than 25% of the baseline value at 72 hours after TAVR. The clinical data of each group were compared, and multivariate logistic regression analysis was performed to analyze the determinants responsible for renal function changes after TAVR. A total of 217 patients were enrolled in this study. The age was (76.7±7.4) years and there were 86 females. The Society of Thoracic Surgeons score was (9.5±5.8). The proportions achieved AKR after TAVR were 0, 30.2% (35/116), 58.6% (41/70) and 75.0% (9/12) respectively in eGFR>90 ml·min·1.73m group, 60<eGFR≤90 ml·min·1.73m group, 30<eGFR≤60 ml·min·1.73m group and eGFR≤30 ml·min·1.73m group. A total of 3 patients (1.4%) suffered AKI, including 2 patients in 30<eGFR≤60 ml·min·1.73m group and 1 patient in 60<eGFR≤90 ml·min·1.73m group. The incidence of AKI in eGFR<60 ml·min·1.73m group was 2.4% (2/82). Among the 217 patients, AKR occurred in 85(39.2%) patients, 3(1.4%) experienced AKI and renal function remained unchanged in 129 (59.4%) patients post TAVR. Body mass index (BMI), left ventricular end diastolic dimension (LVEDD) and preoperative eGFR were statistically different between the 3 groups (<0.05). Multivariate logistic regression analysis showed that BMI (=5.54, 95% 1.04-29.58, =0.045), preoperative LVEDD (=1.22, 95% 1.09-1.38, =0.001) and preoperative eGFR (=2.23, 95% 2.04-2.55, =0.004) were associated with non-AKR post TAVR. After TAVR, most patients show no change or improvement of renal function. BMI, preoperative LVEDD and eGFR are related to renal function change after TAVR.
探讨经导管主动脉瓣置换术（TAVR）对重度主动脉瓣狭窄患者肾功能的影响。这是一项单中心回顾性研究。纳入2014年12月至2019年12月在中山医院接受TAVR的连续性重度主动脉瓣狭窄患者。根据TAVR术前一天测得的估计肾小球滤过率（eGFR）将患者分为四组，即eGFR>90 ml·min·1.73m²组、60<eGFR≤90 ml·min·1.73m²组、30<eGFR≤60 ml·min·1.73m²组和eGFR≤30 ml·min·1.73m²组。根据TAVR术后72小时肾功能变化情况将患者分为急性肾功能恢复（AKR）组、急性肾损伤（AKI）组和肾功能无变化组。AKR定义为TAVR术后72小时eGFR较基线值升高超过25%，AKI定义为TAVR术后72小时eGFR较基线值降低超过25%。比较各组临床资料，并进行多因素logistic回归分析以分析TAVR术后肾功能变化的决定因素。本研究共纳入217例患者。年龄为（76.7±7.4）岁，女性86例。胸外科医师协会评分（9.5±5.8）。eGFR>90 ml·min·1.73m²组、60<eGFR≤90 ml·min·1.73m²组、30<eGFR≤60 ml·min·1.73m²组和eGFR≤30 ml·min·1.73m²组TAVR术后实现AKR的比例分别为0、30.2%（35/116）、58.6%（41/70）和75.0%（9/12）。共3例患者（1.4%）发生AKI，其中30<eGFR≤60 ml·min·1.73m²组2例，60<eGFR≤90 ml·min·1.73m²组1例。eGFR<60 ml·min·1.73m²组AKI发生率为2.4%（2/82）。217例患者中，85例（39.2%）发生AKR，3例（1.4%）发生AKI，129例（59.4%）患者TAVR术后肾功能无变化。三组间体重指数（BMI）、左心室舒张末期内径（LVEDD）和术前eGFR差异有统计学意义（<0.05）。多因素logistic回归分析显示，BMI（β=5.54，95%CI 1.04-29.58，P=0.045）、术前LVEDD（β=1.22，95%CI 1.09-1.38，P=0.001）和术前eGFR（β=2.23，95%CI 2.04-2.55，P=0.004）与TAVR术后非AKR相关。TAVR术后，大多数患者肾功能无变化或改善。BMI、术前LVEDD和eGFR与TAVR术后肾功能变化有关。
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