Risk Factors for Acute Kidney Injury following TA-TAVI or Minimally Invasive Aortic Valve Replacement: Which Procedure Is Less Kidney Damaging in Elderly Patients?
07. Januar 2014
20. Februar 2014
15. Juli 2014 (eFirst)
Background Acute kidney injury (AKI) represents a major complication following aortic valve replacement in elderly patients. The aim of this study was to determine possible risk factors for AKI and to find the ideal strategy, minimally invasive valve replacement (MIS-AVR) or transapical valve implantation (TA-TAVI), regarding the postoperative renal outcome.
Methods A total of 133 patients (age ≥ 75 years, 67 male) with severe aortic stenosis were included over 2 years: 42% were treated with MIS-AVR, 58% underwent TA-TAVI procedure. AKI was considered as a postprocedural 1.5× increase in creatinine or an increase of > 0.3 mg/dL/48 hours. Group differences were tested with chi-square or t-test. AKI risk assumption was analyzed in multiple multivariate logistic regression models.
Results EuroSCORE II–related risk assumption was 8.7 ± 6.9 for TA-TAVI and 4.5 ± 5.7 for MIS-AVR (p < 0.001). The overall 30-day survival rate was 93%. Fifty-eight patients developed a risk for AKI and 13 developed a manifest renal injury/failure. Logistic regression analysis revealed a higher AKI risk for TA-TAVI (odds ratio, OR = 2.58; 95% confidence interval, CI = 1.18, 5.63; p = 0.017). EuroSCORE II (OR = 0.98; 95% CI = 0.92, 1.04; p = 0.433); preoperative creatinine (OR = 1.78; 95% CI = 0.67, 4.77; p = 0.249) and estimated glomerular filtration rate (OR = 1.00; 95% CI = 0.97, 1.02; p = 0.655) had no impact on AKI. A regression model adjusting for the variables age, gender, body mass index (BMI), diabetes, and procedure type revealed a higher AKI rate for male gender (OR = 2.41; 95% CI = 1.13, 5.11; p = 0.022). Operation time and radio-contrast media volume had no influence on the AKI-occurrence. There was no correlation between AKI and early mortality.
Conclusion A higher risk for AKI after TA-TAVI should be considered in the therapy decision, especially in elderly male patients because MIS-AVR still yields excellent results.
- 1 Waikar SS, Bonventre JV. Biomarkers for the diagnosis of acute kidney injury. Curr Opin Nephrol Hypertens 2007; 16 (6) 557-564
- 2 Bagshaw SM, George C, Bellomo R ; ANZICS Database Management Committee. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008; 23 (5) 1569-1574
- 3 Loef BG, Epema AH, Smilde TD , et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 2005; 16 (1) 195-200
- 4 Karkouti K, Wijeysundera DN, Yau TM , et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 2009; 119 (4) 495-502
- 5 Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005; 16 (11) 3365-3370
- 6 Ashikhmina EA, Schaff HV, Dearani JA , et al. Aortic valve replacement in the elderly: determinants of late outcome. Circulation 2011; 124 (9) 1070-1078
- 7 Bagur R, Webb JG, Nietlispach F , et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 2010; 31 (7) 865-874
- 8 Coeytaux RR, Williams Jr JW, Gray RN, Wang A. Percutaneous heart valve replacement for aortic stenosis: state of the evidence. Ann Intern Med 2010; 153 (5) 314-324
- 9 Yan TD, Cao C, Martens-Nielsen J , et al. Transcatheter aortic valve implantation for high-risk patients with severe aortic stenosis: A systematic review. J Thorac Cardiovasc Surg 2010; 139 (6) 1519-1528
- 10 Elhmidi Y, Bleiziffer S, Piazza N , et al. Incidence and predictors of acute kidney injury in patients undergoing transcatheter aortic valve implantation. Am Heart J 2011; 161 (4) 735-739
- 11 Saia F, Ciuca C, Taglieri N , et al. Acute kidney injury following transcatheter aortic valve implantation: incidence, predictors and clinical outcome. Int J Cardiol 2013; 168 (2) 1034-1040
- 12 Levey AS, Coresh J, Greene T , et al; Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145 (4) 247-254
- 13 Kellum JA, Mehta RL, Angus DC, Palevsky P, Ronco C ; ADQI Workgroup. The first international consensus conference on continuous renal replacement therapy. Kidney Int 2002; 62 (5) 1855-1863
- 14 McCullough PA, Soman SS. Contrast-induced nephropathy. Crit Care Clin 2005; 21 (2) 261-280
- 15 Praught ML, Shlipak MG. Are small changes in serum creatinine an important risk factor?. Curr Opin Nephrol Hypertens 2005; 14 (3) 265-270
- 16 Aregger F, Wenaweser P, Hellige GJ , et al. Risk of acute kidney injury in patients with severe aortic valve stenosis undergoing transcatheter valve replacement. Nephrol Dial Transplant 2009; 24 (7) 2175-2179
- 17 Kong WY, Yong G, Irish A. Incidence, risk factors and prognosis of acute kidney injury after transcatheter aortic valve implantation. Nephrology (Carlton) 2012; 17 (5) 445-451
- 18 Drager LF, Andrade L, Barros de Toledo JF, Laurindo FR, Machado César LA, Seguro AC. Renal effects of N-acetylcysteine in patients at risk for contrast nephropathy: decrease in oxidant stress-mediated renal tubular injury. Nephrol Dial Transplant 2004; 19 (7) 1803-1807
- 19 Heyman SN, Rosen S, Khamaisi M, Idée JM, Rosenberger C. Reactive oxygen species and the pathogenesis of radiocontrast-induced nephropathy. Invest Radiol 2010; 45 (4) 188-195
- 20 Investigators ACT ; ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation 2011; 124 (11) 1250-1259
- 21 Alassar A, Roy D, Abdulkareem N, Valencia O, Brecker S, Jahangiri M. Acute kidney injury after transcatheter aortic valve implantation: incidence, risk factors, and prognostic effects. Innovations (Phila) 2012; 7 (6) 389-393
- 22 Khawaja MZ, Thomas M, Joshi A , et al. The effects of VARC-defined acute kidney injury after transcatheter aortic valve implantation (TAVI) using the Edwards bioprosthesis. EuroIntervention 2012; 8 (5) 563-570
- 23 Yamamoto M, Hayashida K, Mouillet G , et al. Renal function-based contrast dosing predicts acute kidney injury following transcatheter aortic valve implantation. JACC Cardiovasc Interv 2013; 6 (5) 479-486
- 24 Madershahian N, Scherner M, Liakopoulos O , et al. Renal impairment and transapical aortic valve implantation: impact of contrast medium dose on kidney function and survival. Eur J Cardiothorac Surg 2012; 41 (6) 1225-1232
- 25 Strauch JT, Scherner M, Haldenwang PL , et al. Transapical minimally invasive aortic valve implantation and conventional aortic valve replacement in octogenarians. Thorac Cardiovasc Surg 2012; 60 (5) 335-342
- 26 Goetzenich A, Deppe I, Schnöring H , et al. EuroScore 2 for identification of patients for transapical aortic valve replacement—a single center retrospective in 206 patients. J Cardiothorac Surg 2012; 7: 89