Acute kidney injury in patients undergoing transcatheter aortic valve replacement: insights on clinical outcomes and prognostic factors

Autor: M Munoz-Garcia, E Munoz-Garcia, A J Munoz Garcia, A J Dominguez-Franco, M F Jimenez-Navarro, J H Alonso-Briales, J M Hernandez-Garcia, J J Gomez-Doblas
Rok vydání: 2021
Předmět:
Zdroj: European Heart Journal. 42
ISSN: 1522-9645
0195-668X
DOI: 10.1093/eurheartj/ehab724.2917
Popis: Acute Kidney Injury (AKI) after cardiac surgery is associated with increased mortality, but very few data exist on the occurrence of AKI associated with Transcatheter Aortic Valve Replacement (TAVR). The aim of this study was to determine the frequency and prognosis of AKI after transcatheter aortic valve replacement. Methods Between April 2008 and December 2019, 751 patients with severe aortic stenosis underwent to TAVR. The AKI was defined according to Valve set by the Academic Research Consortium, as the absolute increase in serum creatinine ≥0.3 mg/dl at 72 hours a percutaneous procedure. Results AKI was identified in 127 patients (16.9%) and 3 patients required renal replacement therapy. After implantation there was a slight improvement in renal function, baseline serum creatinine decreased from 1.37±0.9mg/dl to 1.22±0.6 mg/dl, p=0.01 and glomerular filtration rate (GFR) increased from 49.7±20 to 53.9±22, p In patients with AKI, the mortality at 30 days was 12.6% compared to 1.3% of patients without AKI, [OR=11.08 (95% CI 4.631–26.514) p In the multivariate analysis AKI was an independent predictor of cumulative total mortality [HR=1.644 (95% CI 1.230–2.198), p=0.001] and threatening bleeding [HR=3.623 (95% CI 1.448–8.764), p=0.004], but not cardiovascular mortality [HR=1.496 (95% CI 0,834.2.682), p=0.177]; readmission by heart failure [HR=1.249 (95% CI 0.652–2.392), p=0.502], myocardial infarction [HR=1.929 (95% CI 0.705–5.287), p=0.201]; or stroke [HR=1.662 (95% CI 0.874–3.142), p=0.118]. The predictors of AKI were: general anesthesia [HR=2.112 (1.038–4.246), p=0.039]; the first generation aortic prostheses [HR=3.485 (95% CI 2.211–5.442), p=0.001]; tricuspid regurgitation [HR=1.604 (95% CI 1.057–2.435), p=0.026] and renal chronic failure [HR=2.060 95% CI 1.148–3.699); p=0.015]. Conclusions Deterioration of renal function in patients undergoing TAVR is a serious and frequent complication. The occurrence of AKI was associated with increase early mortality and also was a predictor of worse outcomes throughout 3.65±2 years of follow-up. Funding Acknowledgement Type of funding sources: None.
Databáze: OpenAIRE
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