Nomi Takaomi, Kitamura Akira, Tsujita Miki, Shiko Yuki, Kawasaki Yohei, Nakagawa Hideyuki
Department of Anesthesiology, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka-City, Saitama, Japan.
Research Administration Center, Saitama Medical University, 1397-1 Yamane, Hidaka-City, Saitama, Japan.
Heart Vessels. 2024 Apr;39(4):359-364. doi: 10.1007/s00380-023-02334-w. Epub 2023 Nov 17.
Acute kidney injury (AKI) frequently occurs after cardiac surgery. Recently, transcatheter aortic valve implantation (TAVI), a less invasive option for aortic stenosis (AS), has been increasingly performed, particularly in elderly patients. We retrospectively investigated and compared the incidence and risk factors of postoperative AKI in patients who underwent surgical aortic valve replacement (SAVR) and TAVI. This was a retrospective single-center study. Seven days postoperatively, data were obtained from medical records. Patients were classified into SAVR and TAVI groups based on age, according to the policy of the Japanese Circulation Society. A total of 155 patients underwent surgery for AS between January 2020 and December 2021. Variables included age, sex, risk score, preoperative left ventricular ejection fraction, hypertension, and renal dysfunction. AKI was defined in accordance with the Kidney Disease: Improving Global Outcomes criteria. A total of 33 SAVR and 79 TAVI procedures were included in this study. The incidences of AKI in the SAVR and TAVI groups were 45.5% and 43.0%, respectively. No significant differences existed between the two groups. Weight (p = 0.0392) and pre-renal dysfunction (p = 0.0308) affected the incidence of AKI in the SAVR group, whereas no such variables were identified in the TAVI group. Within the current age-based treatment selection criteria for AS, no significant difference in the incidence of AKI was observed between the two procedures.Although preoperative renal function may be associated with postoperative AKI, further studies are required to select the optimal surgical procedure for patients with renal dysfunction.
急性肾损伤（AKI）常在心脏手术后发生。近年来，经导管主动脉瓣植入术（TAVI）作为一种侵入性较小的主动脉瓣狭窄（AS）治疗选择，应用越来越广泛，尤其是在老年患者中。我们回顾性研究并比较了接受外科主动脉瓣置换术（SAVR）和TAVI的患者术后AKI的发生率及危险因素。这是一项回顾性单中心研究。术后7天，从病历中获取数据。根据日本循环学会的政策，根据年龄将患者分为SAVR组和TAVI组。2020年1月至2021年12月期间，共有155例患者接受了AS手术。变量包括年龄、性别、风险评分、术前左心室射血分数、高血压和肾功能不全。AKI根据改善全球肾脏病预后组织（KDIGO）标准定义。本研究共纳入33例SAVR手术和79例TAVI手术。SAVR组和TAVI组的AKI发生率分别为45.5%和43.0%。两组之间无显著差异。体重（p = 0.0392）和肾前性肾功能不全（p = 0.0308）影响SAVR组AKI的发生率，而TAVI组未发现此类变量。在目前基于年龄的AS治疗选择标准内，两种手术的AKI发生率无显著差异。虽然术前肾功能可能与术后AKI有关，但仍需要进一步研究以选择肾功能不全患者的最佳手术方式。
