AKI after Transcatheter or Surgical Aortic Valve Replacement.
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis who are at high risk of perioperative mortality. Previous studies showed increased risk of postoperative AKI with TAVR, but it is unclear whether differences in patient risk profiles confounded the results. To conduct a propensity-matched study, we identified all adult patients undergoing isolated aortic valve replacement for aortic stenosis at Mayo Clinic Hospital in Rochester, Minnesota from January 1, 2008 to June 30, 2014. Using propensity score matching on the basis of clinical characteristics and preoperative variables, we compared the postoperative incidence of AKI, defined by Kidney Disease Improving Global Outcomes guidelines, and major adverse kidney events in patients treated with TAVR with that in patients treated with SAVR. Major adverse kidney events were the composite of in-hospital mortality, use of RRT, and persistent elevated serum creatinine ≥200% from baseline at hospital discharge. Of 1563 eligible patients, 195 matched pairs (390 patients) were created. In the matched cohort, baseline characteristics, including Society of Thoracic Surgeons risk score and eGFR, were comparable between the two groups. Furthermore, no significant differences existed between the TAVR and SAVR groups in postoperative AKI (24.1% versus 29.7%; P=0.21), major adverse kidney events (2.1% versus 1.5%; P=0.70), or mortality >6 months after surgery (6.0% versus 8.3%; P=0.51). Thus, TAVR did not affect postoperative AKI risk. Because it is less invasive than SAVR, TAVR may be preferred in high-risk individuals.
Division of Nephrology and Hypertension, Department of Internal Medicine.
Charat
C
Thongprayoon
Division of Nephrology and Hypertension, Department of Internal Medicine.
Wisit
W
Cheungpasitporn
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine.
Narat
N
Srivali
Medical Scientist Training Program.
Andrew M
AM
Harrison
Division of Biomedical Statistics and Informatics, and.
Tina M
TM
Gunderson
Division of Nephrology and Hypertension, Department of Internal Medicine.
Wonngarm
W
Kittanamongkolchai
Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Kevin L
KL
Greason
Division of Nephrology and Hypertension, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, kashani.kianoush@mayo.edu.
Kianoush B
KB
Kashani
D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects
acute renal failure; cardiovascular disease; outcomes