Minimally Invasive Transapical Aortic Valve Implantation and the Risk of Acute Kidney Injury

摘要

Patient Characteristics and Inclusion CriteriaProsthetic Valve System and ProcedureData Collection, Definitions of AKI, and Patient DemographicsResultsSerum Creatinine Levels and Development of AKIMorbidity and MortalityThe new technique of minimally invasive transapical aortic valve implantation (TAP-AVI) deals with high-risk patients and despite the absence of cardiopulmonary bypass it might lead to renal impairment. The aim of this study was to estimate the risk of the development of acute kidney injury (AKI) after TAP-AVI and to identify possible risk factors with regard to the morbidity and mortality of the patients.MethodsData of 30 consecutive patients undergoing TAP-AVI were recorded and followed up for 8 weeks. Postoperative AKI has been defined according to RIFLE criteria. Two patients on chronic hemodialysis have been followed up.ResultsOf 28 patients, AKI occurred in 16 patients (57%). Statistical analysis revealed no influence on the risk of developing AKI caused by the dose of applicated contrast medium (p = 0.09), the patient's age (p = 0.5), or the existence of diabetes (p = 0. 16). Analysis concerning the relationship between a preexisting coronary heart disease and AKI showed a tendency to be associated with a higher risk of the development of AKI (70% preexisting congenital heart disease in the AKI group versus 50%; p = 0.28). Only a preoperative serum creatinine greater than 1.1 mg/dL was a strong predictor for developing AKI (p < 0.01). Length of stay in the intensive care unit and the complete length of hospital stay revealed no difference with regard to postoperative development of AKI though statistical analysis showed a trend to a higher mortality in the AKI group (27% vs 6%); univariate analysis did not reach statistical significance (p = 0.13).ConclusionsThe TAP-AVI seems to be a feasible procedure for high-risk patients with a clear risk of developing AKI. Patients at risk should be identified and, if indicated, already preoperatively treated in collaboration with the attending nephrologists.CTSNet classification:35The treatment of choice for patients with symptomatic severe degenerative aortic stenosis, which is the most frequently acquired heart valve lesion, is the surgical aortic valve replacement (AVR) with cardiopulmonary bypass (CBP). Due to the fact that medically managed symptomatic patients have a poor prognosis [