Predictors for and Consequences of Acute Kidney Injury After Surgical Aortic Valve Replacement: An Observational...

Background/Objectives: Acute renal injury (AKI) after surgical aortic valve replacement (SAVR) is a serious postoperative complication, associated with an increased need for resources and an increase in early mortality. Methods: In 2006-2017, 1548 patients underwent SAVR with or without an associated procedure. Preoperative and operative factors, as well as adverse postoperative events, were registered. The outcome was AKI defined by a decrease in the estimated glomerular filtration rate (eGFR) of at least 25%. Statistical analysis was performed with chi-square test and Student's t-test. Significant factors were entered into a logistic regression analysis. AKI's effect on long-term survival was determined via Kaplan-Meier analysis and Cox's proportional hazard analysis. Results: AKI occurred in 447/1548 or 30.7% of the patients. Most preoperative cardiac and non-cardiac factors were associated with AKI. Prior endocarditis and a decreased eGFR were the dominant preoperative factors for early mortality, while a need for reintervention was the dominant postoperative event. AKI was also associated with prolonged surgical time and an increased need for resources. In patients who died within 30 days, AKI was not the sole complication. AKI also significantly reduced survival in the univariate analysis, revealing that AKI was a significant, independent predictor of survival, albeit the least strong. Conclusions: AKI is a serious postoperative complication associated with mostly non-modifiable factors. Postoperative AKI predicts reduced long-term survival.