Prognostic Value of Renal Function in Patients Treated with transcatheter Aortic Valve Replacement and Percutaneous Coronary Intervention versus Surgical Aortic Valve Replacement with Coronary Artery Bypass Grafting (TAVR PCI vs. SAVR CABG)

Background: The present study aimed to analyze the variation of renal function after aortic valve replacement in patients with complex coronary artery disease focused on acute kidney injury and its impact on short- and mid-term outcomes.

Method: Between January 2010 and December 2020, a total of 1,232 patients underwent TAVR and PCI or SAVR with CABG in our center. Complex coronary artery disease with a SYNTAX I score > 22 was an inclusion criterion. Kidney injury was defined according to VARC-2 criteria. The renal function–corrected ratio of contrast medium and body weight was calculated to determine the risk of postprocedural contrast-associated acute kidney injury (AKI). Renal retention values were, respectively, collected until the seventh day after the procedure.

Results: Eighty pairs of patients (40 TAVR PCI vs. 40 SAVR CABG) with intermediate STS risk score 3.2 ± 0.3 and EuroSCORE II 4.1 ± 0.3 were generated after 1:1 propensity score matching. The incidence of postprocedural AKI statistically did not differ in both groups and was not related to the amount of contrast dye. There were no significant differences between groups for all-cause mortality (p = 0.218; HR: 1.5; 95% CI: 0.7–3.2), stroke (p = 0.521; HR: 2.4; 95% CI: 1.1–5.7), myocardial infarction (p = 0.656; HR: 0.6; 95% CI: 0.1–6.4), need for new coronary revascularization (p = 0.505; HR: 2.2; 95% CI: 0.1–24.5), but there were a significant higher rates of MACCE (p = 0.038; HR: 2.4; 95% CI: 1.1–5.7) and new pacemaker insertion (p = 0.021; HR: 7.9; 95% CI: 1.5–40.9) in the TAVR PCI group. Similarly, the rate of re-AVR was higher in the TAVR PCI group, without significance (p = 0.079; HR: 7.8; 95% CI: 0.8–77.0). After multivariable-adjusted models, there was no correlation between impaired renal function and short- or mid-term mortality.

Conclusion: Renal function and occurrence of AKI were not related to the amount of contrast medium, which has no impact on short- and mid-term mortality. The percutaneous transcatheter approach presents similar outcomes to a surgical approach. However, SAVR CABG was superior to TAVR PCI regarding MACCE and new pacemaker insertion rates. Future trials are needed to guide clinical decisions.

Publication History

Article published online:
28 January 2023