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AKI after Transcatheter or Surgical Aortic Valve Replacement
Charat Thongprayoon1, Wisit Cheungpasitporn1, Narat Srivali2
1Division of Nephrology and Hypertension, Department of Internal Medicine.
Journal of the American Society of Nephrology : JASN
|October 22, 2015
Summary
Transcatheter aortic valve replacement (TAVR) shows no increased risk of postoperative acute kidney injury (AKI) compared to surgical aortic valve replacement (SAVR). This less invasive option may be preferred for high-risk patients with severe aortic stenosis.
Area of Science:
- Cardiology
- Nephrology
- Surgical Innovation
Background:
- Transcatheter aortic valve replacement (TAVR) is an alternative for severe aortic stenosis in high-risk patients.
- Previous studies suggested higher postoperative acute kidney injury (AKI) rates with TAVR, but confounding by patient risk profiles was unclear.
Purpose of the Study:
- To compare the postoperative incidence of AKI and major adverse kidney events between TAVR and surgical aortic valve replacement (SAVR).
- To determine if TAVR impacts AKI risk after adjusting for patient characteristics using propensity score matching.
Main Methods:
- Propensity score matching was used to compare 195 pairs of adult patients undergoing isolated aortic valve replacement for aortic stenosis.
- Patient data were collected from January 2008 to June 2014 at Mayo Clinic Hospital.
- AKI was defined by KDIGO guidelines; major adverse kidney events included mortality, RRT, and persistent elevated creatinine.
Main Results:
- Baseline characteristics, including STS risk score and eGFR, were comparable between TAVR and SAVR groups post-matching.
- No significant differences were found in postoperative AKI (24.1% vs. 29.7%, P=0.21) or major adverse kidney events (2.1% vs. 1.5%, P=0.70).
- Long-term mortality (>6 months) was also similar between the TAVR and SAVR groups (6.0% vs. 8.3%, P=0.51).
Conclusions:
- Transcatheter aortic valve replacement (TAVR) does not increase the risk of postoperative acute kidney injury (AKI) compared to surgical aortic valve replacement (SAVR) in a propensity-matched cohort.
- TAVR is a viable and potentially preferred option for high-risk patients with severe aortic stenosis due to its less invasive nature and similar kidney outcomes.
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