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Evolution of chronic kidney disease after surgical aortic valve replacement or transcatheter aortic valve

Adrien Reuillard1, Cyril Garrouste2, Bruno Pereira3

  • 1Service de cardiologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.

Archives of Cardiovascular Diseases
|January 19, 2019
PubMed

Insights

Aortic valve replacement, via surgery or transcatheter methods, improved kidney function in over half of patients with advanced chronic kidney disease (CKD) one year post-procedure. Acute kidney injury was linked to long-term kidney function decline in CKD patients.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Interventional Cardiology

Background:

  • Immediate kidney function improvement is noted post-aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI).
  • Long-term kidney function evolution after AVR or TAVI remains understudied, particularly in patients with moderate to severe chronic kidney disease (CKD).

Purpose of the Study:

  • To evaluate the long-term (1-year) impact of surgical AVR (SAVR) and transcatheter aortic valve implantation (TAVI) on kidney function.
  • To assess kidney function changes in patients with chronic kidney disease (CKD) stages 3b-5 following aortic stenosis treatment.

Main Methods:

  • Retrospective analysis of patients with CKD stages 3b-5 undergoing SAVR or TAVI for aortic stenosis.
  • Kidney function assessed by estimated glomerular filtration rate (eGFR) at 1 year post-procedure.
  • Improvement/deterioration defined as a change of ±5 mL/min/1.73 m² in eGFR.

Main Results:

  • Kidney function improved in 51% of patients at 1 year, with no significant difference between SAVR (45%) and TAVI (57%).
  • A significant eGFR increase (>15 mL/min/1.73 m²) was observed in 23% of patients, sustained at follow-up.
  • Acute kidney injury (AKI) emerged as an independent predictor of long-term kidney function deterioration (OR 2.1, P=0.006).

Conclusions:

  • Aortic valve replacement, irrespective of method (SAVR or TAVI), enhances eGFR in over half of patients with advanced CKD at one year.
  • The findings support AVR as a beneficial intervention for improving kidney function in selected CKD patients with aortic stenosis.
  • AKI is a critical factor influencing long-term renal outcomes post-AVR/TAVI in this patient cohort.
Abstract

Keywords:
Chronic kidney diseaseDébit de filtration glomérulaireFonction rénaleGlomerular filtration rateInsuffisance rénale chroniqueKidney functionRemplacement valvulaire aortique chirurgicalRemplacement valvulaire aortique percutanéSurgical aortic valve replacementTranscatheter aortic valve implantation

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