Risk of acute kidney injury in patients with severe aortic valve stenosis undergoing transcatheter valve replacement
Risk of acute kidney injury in patients with severe aortic valve stenosis undergoing transcatheter valve replacement
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DOI：
10.1093/ndt/gfp036
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发表时间：
2009-07-01
影响因子：
6.1
通讯作者：
Frey, Felix J.
中科院分区：
文献类型：
--
作者：
Aregger, Fabienne;Wenaweser, Peter;Frey, Felix J.
方法。我们回顾性分析了 58 名患者的肾脏基线特征和结果，其中包括 2 名在我们机构接受 TAVI 的慢性血液透析患者。急性肾损伤（AKI）根据 RIFLE 分类进行定义。结果。 58 名患有严重症状的主动脉瓣狭窄且不适合进行传统瓣膜置换术的患者接受了 TAVI，平均年龄为 83 +/- 5 岁。两名患者在经股动脉瓣膜植入期间死亡，两名患者在 TAVI 术后第一个月死亡，导致 30 天死亡率为 6.9%。 46 名患者的血管通路为经股动脉，12 名患者的血管通路为经心尖。30 名患者 (56%) 的估计肾小球滤过率 (eGFR) 增加。 15 名患者 (28%) 出现 AKI，其中 4 名患者必须暂时透析，1 名患者仍接受慢性肾脏替代治疗。 AKI 的危险因素包括经心尖入路、输血次数、介入后血小板减少症和严重炎症反应综合征 (SIRS)。结论。 TAVI 对于合并症负担较高的患者和既往患有终末期肾病的患者是可行的，否则这些患者不会被视为常规主动脉瓣置换术的候选者。尽管超过一半患者的 GFR 有所改善，但这种益处与介入后 AKI 的风险相关。未来的研究应确定围手术期肾损伤的预防措施。
Methods. We analysed retrospectively renal baseline characteristics and outcome in 58 patients including 2 patients on chronic haemodialysis undergoing TAVI at our institution. Acute kidney injury (AKI) was defined according to the RIFLE classification.Results. Fifty-eight patients with severe symptomatic aortic stenosis not considered suitable for conventional surgical valve replacement with a mean age of 83 +/- 5 years underwent TAVI. Two patients died during transfemoral valve implantation and two patients in the first month after TAVI resulting in a 30-day mortality of 6.9%. Vascular access was transfemoral in 46 patients and transapical in 12. Estimated glomerular filtration rate (eGFR) increased in 30 patients (56%). Fifteen patients (28%) developed AKI, of which four patients had to be dialyzed temporarily and one remained on chronic renal replacement therapy. Risk factors for AKI comprised, among others, transapical access, number of blood transfusions, postinterventional thrombocytopaenia and severe inflammatory response syndrome (SIRS).Conclusions. TAVI is feasible in patients with a high burden of comorbidities and in patients with pre-existing end-stage renal disease who would be otherwise not considered as candidates for conventional aortic valve replacement. Although GFR improved in more than half of the patients, this benefit was associated with a risk of postinterventional AKI. Future investigations should define preventive measures of peri-procedural kidney injury.