Journal of Chest Surgery (Dec 2022)

The Impact of Surgical versus Transcatheter Aortic Valve Replacement on Postprocedural Acute Kidney Injury in Patients with Chronic Kidney Disease

  • Eun Chae Kim,
  • Sue Hyun Kim,
  • Yeiwon Lee,
  • Suk Ho Sohn,
  • Jae Woong Choi,
  • Jeehoon Kang,
  • Jung Kyu Han,
  • Kyung Hwan Kim,
  • Hyo-Soo Kim,
  • Ho Young Hwang

DOI
https://doi.org/10.5090/jcs.22.029
Journal volume & issue
Vol. 55, no. 6
pp. 435 – 441

Abstract

Read online

Background: This study aimed to evaluate the impact of the treatment modality on post-procedural acute kidney injury (AKI) and other clinical outcomes in patients with advanced chronic kidney disease who underwent surgical or transcatheter aortic valve replacement (AVR). Methods: A total of 147 patients with advanced chronic kidney disease (stage 3 to 5) who underwent isolated surgical AVR (SAVR group; n=70) or transcatheter AVR (TAVR group; n=77) were retrospectively studied. Postprocedural AKI was defined according to the RIFLE definition (an acronym corresponding to the risk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage kidney disease). Factors associated with postoperative complications and mortality were analyzed using multivariable logistic regression models and Cox proportional hazard models. Results: Postprocedural AKI occurred in 17 (24.3%) and 6 (7.8%) patients in the SAVR and TAVR groups, respectively (p=0.006). Multivariable analyses demonstrated that the SAVR group had higher risks of AKI (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.85–17.73; p=0.002) and atrial fibrillation (OR, 16.65; 95% CI, 4.44–62.50; p<0.001), whereas the TAVR group had a higher risk of permanent pacemaker insertion (OR, 5.67; 95% CI, 1.21–26.55; p=0.028). The Cox proportional hazard models showed that the occurrence of AKI, contrary to the treatment modality, was associated with overall survival. Conclusion: In patients with chronic kidney disease, the risk of postprocedural AKI might be higher after SAVR than after TAVR.

Keywords