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OBJECTIVE: Acute kidney injury (AKI) represents a major complication following aortic valve replacement in elderly high-risk patients. The aim of this study was to determine the ideal strategy, minimal invasive valve replacement (MIS-AVR) or transapical valve implementation (TA-TAVI), regarding the postoperative renal function.
METHODS: 133 patients (67 male) with severe aortic stenosis and age ≥75 years were included over two years: 42% were treated with MIS-AVR, 58% underwent TA-TAVI-procedure. AKI was considered as a post-procedural 1.5x increase in creatinine or an increase of >0.3 mg/dl over 48h. Group differences were tested with chi-square or t-test. Risk assumption for AKI was analyzed in multiple multivariate logistic regression models
RESULTS: EuroSCORE II risk assumption was 8.7 ± 6.9 for TA-TAVI and 4.5 ± 5.7 for MIS-AVR (p<0.001). The overall 30-day survival rate was 93%. 58 patients developed a risk for AKI and 13 a manifest renal injury/failure. Multiple multivariate regression models revealed a higher risk of AKI for the TA-TAVI (OR 2.82; 95%CI [1.33, 5.98], p=0.007). Neither the EuroSCORE II (OR 0.99; 95%CI [0.94, 1.05], p=0.722) nor the pre-operative creatinine level (OR 2.05; 95%CI [0.93, 4.56], p=0.076) had any impact on AKI. The regression model adjusting for the variables age, gender, BMI, diabetes and the procedure-type revealed a higher AKI-rate for male gender (OR 2.41; 95%CI [1.13, 5.11], p=0.022). The operation time and the amount of radio-contrast media had no influence on the occurrence of AKI. There was no correlation between AKI and early mortality.
CONCLUSIONS: A higher risk for AKI after TA-TAVI should be considered in the therapy decision, especially in elderly male patients, since MIS-AVR still yields excellent results.