Servicio de Anestesiología, Centro Hospitalar Universitario Sao Joao, Porto, Portugal; MEDCIDS, Departamento de Medicina da Comunidad, Información y Decisión en Salud, Facultad de Medicina de Universidad de Porto, Porto, Portugal.
Facultad de Medicina de Universidad de Porto, Porto, Portugal.
Rev Esp Anestesiol Reanim (Engl Ed). 2021 Mar;68(3):121-127. doi: 10.1016/j.redar.2020.09.013. Epub 2021 Jan 22.
Anesthetic techniques have been reported as having an impact on acute kidney injury (AKI) incidence in the postoperative period in patients undergoing transcatheter aortic valve implantation (TAVI). This study aimed to assess whether exists an association between anesthetic approach in patients undergoing TAVI and the post-operative AKI incidence. The existence of association between anesthetic approach and mortality was also assessed.
A retrospective, single-center, observational study was conducted at the Centro Hospitalar Universitário de São João, a Portuguese reference center. All patients undergoing TAVI from January 2015 to June 2018 were recruited and were divided into two groups for analysis: general anesthesia (GA) and sedation.
One hundred and seven patients underwent TAVI (GA: n = 24; sedation: n = 83) and the overall incidence of AKI was 14.02%. We found a higher incidence of intraoperative hypotension in the GA group (83.3 vs. 33.7%, p < 0.001). Regarding postoperative outcomes, there were no significant differences in AKI incidence (20.8 vs. 12.0%, p = 0.319) and mortality. A significant association was found between postoperative AKI and preexisting chronic kidney disease (CKD), preoperative heart failure functional class, intraoperative hypotension, longer length of stay in level II unit, longer hospital stay and worsening of previous CKD stage.
It was not possible to established association between the anesthetic approach for TAVI procedures and postoperative AKI and mortality. Our study reinforces the importance of preventing AKI incidence, considering its impact on the worsening of baseline CKD and on the length of stay, leading to higher hospitalization costs.
有报道称，在接受经导管主动脉瓣植入术（TAVI）的患者中，麻醉技术会影响术后急性肾损伤（AKI）的发生率。本研究旨在评估 TAVI 患者的麻醉方法与术后 AKI 发生率之间是否存在关联。还评估了麻醉方法与死亡率之间的关联。
这是一项在葡萄牙参考中心圣若昂大学医院中心进行的回顾性、单中心、观察性研究。招募了 2015 年 1 月至 2018 年 6 月期间接受 TAVI 的所有患者，并将其分为两组进行分析：全身麻醉（GA）和镇静。
共有 107 例患者接受了 TAVI（GA：n=24；镇静：n=83），AKI 的总体发生率为 14.02%。我们发现 GA 组术中低血压的发生率更高（83.3%比 33.7%，p<0.001）。关于术后结果，AKI 发生率（20.8%比 12.0%，p=0.319）和死亡率无显著差异。术后 AKI 与术前存在的慢性肾脏病（CKD）、术前心力衰竭功能分级、术中低血压、二级病房住院时间延长、住院时间延长和 CKD 分期恶化显著相关。
TAVI 手术的麻醉方法与术后 AKI 和死亡率之间未建立关联。我们的研究强调了预防 AKI 发生率的重要性，因为它会影响基础 CKD 的恶化程度以及住院时间，从而导致更高的住院费用。
