Lee Hoo Seung, Cho Youn Joung, Yoo Seungho, Lee Seohee, Ju Jae-Woo, Nam Karam, Jeon Yunseok
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Clin Monit Comput. 2025 Aug 13. doi: 10.1007/s10877-025-01339-2.
Acute kidney injury (AKI) is a common complication and a strong risk factor for adverse outcomes after transcatheter aortic valve implantation (TAVI). Renal regional tissue oxygen saturation (rSO) reflects tissue perfusion and can be measured using near-infrared spectroscopy. We hypothesized that decrease in renal rSO during TAVI would predict post-procedural AKI.
Patients with severe aortic stenosis who scheduled for transfemoral TAVI were enrolled. Patients undergoing emergent procedures, those with severe renal impairment, those with a distance from skin to renal capsule > 4 cm, those on mechanical ventilation, or those who refused to participate were excluded. The primary outcome was the relationship between changes in renal rSO during TAVI and post-procedural AKI. AKI was determined according to the Valve Academic Research Consortium-2 criteria.
Sixty-four patients were included and analyzed. The mean (standard deviation [SD]) age of patients was 82 (4) years, and the median [interquartile range] procedure time was 75 [65-90] min. The incidence of post-procedural AKI was 33% (21/64). There was no difference in the mean (SD) time-weighted renal rSO (70% [13%] and 73% [11%]), changes in renal rSO (-14% [10%] and - 15% [13%]), or nadir rSO (55% [17%] and 60% [17%]) during TAVI between patients who developed post-TAVI AKI and those who did not (p = 0.227, 0.157, and 0.333, respectively). In multivariable regression analysis, renal rSO variables were not predictors of post-TAVI AKI.
Procedural changes in renal rSO measured using near-infrared spectroscopy did not predict the development of post-TAVI AKI. Further studies are needed to investigate more effective strategies to predict and prevent AKI following TAVI.
This study was registered on cinicaltrials.gov (identifier, NCT04921475, registered on June 10, 2021).
急性肾损伤（AKI）是经导管主动脉瓣植入术（TAVI）后常见的并发症及不良预后的重要危险因素。肾脏局部组织氧饱和度（rSO）反映组织灌注情况，可通过近红外光谱法进行测量。我们推测TAVI期间肾脏rSO降低可预测术后AKI。
纳入计划行经股动脉TAVI的重度主动脉瓣狭窄患者。排除接受急诊手术的患者、严重肾功能不全患者、皮肤至肾包膜距离>4 cm的患者、机械通气患者或拒绝参与者。主要结局是TAVI期间肾脏rSO变化与术后AKI之间的关系。AKI根据瓣膜学术研究联盟-2标准判定。
纳入并分析了64例患者。患者的平均（标准差[SD]）年龄为82（4）岁，中位[四分位间距]手术时间为75[65 - 90]分钟。术后AKI的发生率为33%（21/64）。发生TAVI术后AKI的患者与未发生者在TAVI期间的平均（SD）时间加权肾脏rSO（分别为70%[13%]和73%[11%]）、肾脏rSO变化（分别为-14%[10%]和-15%[13%]）或最低rSO（分别为55%[17%]和60%[17%]）方面无差异（p分别为0.227、0.157和0.333）。在多变量回归分析中，肾脏rSO变量不是TAVI术后AKI的预测因素。
使用近红外光谱法测量的术中肾脏rSO变化不能预测TAVI术后AKI的发生。需要进一步研究以探讨预测和预防TAVI术后AKI的更有效策略。
本研究在clinicaltrials.gov上注册（标识符，NCT04921475，于2021年6月10日注册）。
