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经导管主动脉瓣置换术后围手术期肾功能变化:中国单中心回顾性研究。

Perioperative renal function change after transcatheter aortic valve replacement: A single-center retrospective study in China.

机构信息

National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China.

Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

出版信息

Perfusion. 2024 May;39(4):759-765. doi: 10.1177/02676591231158742. Epub 2023 Mar 1.

Abstract

BACKGROUND

In recent years, the kidney function after Transcatheter Aortic Valve Replacement (TAVR) has gradually become a hot spot that arouse extensive attention.Our study is aimed to evaluate the incidence and predictors of acute kidney recovery (AKR) after TAVR.

METHODS

A total of 102 patients undergoing TAVR in Beijing Anzhen Hospital from June 2021 to March 2022 were enrolled in our study. Patients were divided into AKR group ( = 54), unchanged group ( = 40) and acute kidney injury (AKI) group ( = 8) based on the percent change of estimated glomerular filtration rate (eGFR). Univariate analysis was used to compare the differences in general clinical characteristics and other related indicators between the three groups to analyze the risk factors of AKR.

RESULTS

The incidence of AKR was 53% (54/102) after TAVR. Multivariate analysis showed that the incidence of age and proportion of severe NYHA class (III or IV) was significantly higher in the AKR group while renal dysfunction (eGFR <60 mL/min/1.73 m) was lower. Besides, fluid management/volume therapy was significantly different among the three groups.

CONCLUSIONS

AKR is a generalizable phenomenon occurring frequently after TAVR. The age, proportion of severe NYHA class and the baseline renal function are independent predictors of AKR events in patients with severe aortic stenosis undergoing TAVR.

摘要

背景

近年来,经导管主动脉瓣置换术(TAVR)后的肾功能逐渐成为研究热点。本研究旨在评估 TAVR 后急性肾恢复(AKR)的发生率和预测因素。

方法

本研究纳入了 2021 年 6 月至 2022 年 3 月在北京安贞医院接受 TAVR 的 102 例患者。根据估算肾小球滤过率(eGFR)的变化百分比,患者被分为 AKR 组(n=54)、无变化组(n=40)和急性肾损伤(AKI)组(n=8)。采用单因素分析比较三组间一般临床特征和其他相关指标的差异,分析 AKR 的危险因素。

结果

TAVR 后 AKR 的发生率为 53%(54/102)。多因素分析显示,AKR 组年龄和严重纽约心脏协会(NYHA)分级比例(III 或 IV 级)的发生率明显较高,而肾功能障碍(eGFR<60ml/min/1.73m)的发生率较低。此外,三组间的液体管理/容量治疗有显著差异。

结论

AKR 是 TAVR 后常见的普遍现象。年龄、严重 NYHA 分级比例和基线肾功能是严重主动脉瓣狭窄患者接受 TAVR 后 AKR 事件的独立预测因素。

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