Katz Matthew S, Greason Kevin L, Crestanello Juan A, Mankad Sunil V, Guerrero Mayra E, Gulati Rajiv, Alkhouli Mohamad, Michelena Hector I, Nkomo Vuyisile T, Rihal Charanjit S, Eleid Mackram F
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States.
Int J Cardiol Heart Vasc. 2022 Mar 14;39:100999. doi: 10.1016/j.ijcha.2022.100999. eCollection 2022 Apr.
Renal dysfunction is frequently encountered in patients with aortic prosthesis degeneration requiring valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR). The effect of VIV TAVR on renal function in patients with bioprosthetic aortic regurgitation (AR) and stenosis (AS) is unknown.
The aims of this study were to describe the change in renal function after VIV TAVR and to compare differences in renal function changes in those with predominant prosthetic regurgitation compared to stenosis.
All VIV TAVR between June of 2014, and October 2019 (n = 141) at a single institution were reviewed. Baseline renal function parameters including estimated glomerular filtration rate (eGFR) were compared with post-discharge follow-up values in both prosthetic AR and AS patient groups. Linear regression analysis was performed to determine correlates of renal function change.
Mean baseline eGFR was lower in the AR group (55 SD21 vs. 64 SD24 ml/min/1.73 m p = 0.0495). At post-discharge follow-up there was an increase in mean eGFR in the AR group which was not present in the AS group (8 SD12 vs. 0 SD11 ml/min/1.73 m respectively p = 0.0006). There were strong correlations between change in creatinine (β = -0.57, R = 0.64, p < 0.0001) and BUN (β = -0.61, R = 0.51, p < 0.0001), and pre-procedure values in the AR group.
Patients who underwent VIV TAVR for AR experienced significant improvement of renal function at post-discharge follow-up. More advanced renal dysfunction at baseline was associated with greater improvement in renal function at post discharge in AR patients.
肾功能不全在需要进行瓣中瓣（VIV）经导管主动脉瓣置换术（TAVR）的主动脉人工瓣膜退化患者中经常出现。VIV TAVR对生物人工主动脉瓣反流（AR）和狭窄（AS）患者肾功能的影响尚不清楚。
本研究的目的是描述VIV TAVR术后肾功能的变化，并比较以人工瓣膜反流为主的患者与以狭窄为主的患者在肾功能变化方面的差异。
回顾了2014年6月至2019年10月期间在单一机构进行的所有VIV TAVR手术（n = 141）。在人工瓣膜AR和AS患者组中，将包括估计肾小球滤过率（eGFR）在内的基线肾功能参数与出院后随访值进行比较。进行线性回归分析以确定肾功能变化的相关因素。
AR组的平均基线eGFR较低（55±21 vs. 64±24 ml/min/1.73 m²，p = 0.0495）。在出院后随访时，AR组的平均eGFR有所增加，而AS组则没有（分别为8±12 vs. 0±11 ml/min/1.73 m²，p = 0.0006）。AR组中肌酐变化（β = -0.57，R = 0.64，p < 0.0001）和尿素氮（β = -0.61，R = 0.51，p < 0.0001）与术前值之间存在强相关性。
接受VIV TAVR治疗AR的患者在出院后随访时肾功能有显著改善。基线时更严重的肾功能不全与AR患者出院后肾功能的更大改善相关。
