Thorac Cardiovasc Surg 2012; 60 - V95
DOI: 10.1055/s-0031-1297485

Impact of severe acute kidney injury on immediate and mid-term outcome in patients undergoing transapical aortic valve implantation

N Teucher 1, BC Danner 1, M Friedrich 1, T Viel 2, M Puls 2, GG Hanekop 3, W Schillinger 2, FA Schöndube 1, RG Seipelt 1
  • 1Universitätsmedizin Göttingen, Klinik für Thorax-, Herz- und Gefäßchirurgie, Göttingen, Germany
  • 2Universitätsmedizin Göttingen, Klinik für Kardiologie und Pneumologie, Göttingen, Germany
  • 3Universitätsmedizin Göttingen, Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Göttingen, Germany

Objectives: The aim of this study was to evaluate effects of acute kidney injury (AKI) on immediate and mid-term outcome in patients after transcatheter aortic valve implantation (TAVI) with transapical approach.

Methods: 93 patients were enrolled consecutively after transapical TAVI. Renal function was classified using modified Riffle criteria. Analysis was performed comparing patients with severe AKI (stage 2/3) vs. no or mild AKI (stage 0/1) following TAVI with respect of baseline characteristics and potential risk factors.

Results: Following transapical TAVI 23/93 patients (24.7%) developed severe AKI. Both groups did not differ significantly in age (79.5±6.9 vs. 82.5±4.8yrs) ejection fraction (47.4±11.5 vs.50.3±11.3%) and logistic EuroScore (32.2±18.9 vs. 25.1±13.2%). In patients developing severe AKI post valve implantation, the preop creatinine value was significantly increased (1.5±0.6 vs. 1.1±0.4 md/dl; P=.014) and the rate of diabetes mellitus higher (52.2 vs. 25.7%; P=.023). There were no differences in duration of procedure (86.3±44 vs. 75.8±36.8min) and dose of contrast agent (92.2±44.7 vs. 84.8±28.3ml) Severe AKI was associated with prolonged post-procedure ventilation time, stay at the ICU and days to discharge. Thirty-day mortality was increased by severe AKI (26.1 vs. 5.7%; P=.013), whereas mid-term survival after discharge from hospital was similar.

Conclusion: Occurrence of severe AKI following TAVI is common and a major complication with increased morbidity and 30-day mortality. Interestingly, we did not find a link between amount of contrast agent and incidence of severe AKI. Severe AKI was no negative prognostic marker on mid-term outcome.