Acute Kidney Injury Following Surgical Aortic Valve Replacement

Abstract

Background Acute kidney injury (AKI) is a significant complication of surgical aortic valve replacement (SAVR). This study sought to describe AKI following SAVR, its risk factors, predictors and effect on long-term survival. Methods We retrospectively reviewed 2169 patients who underwent isolated SAVR between 2000 and 2012. The main end-points were occurrence of AKI, postoperative complications, and short-and long-term survival rates following SAVR. Patients were divided into two groups: AKIR (n = 181) and AKIS (n = 1945). Results AKI occurred in 8.5% of patients, of which 3.9% (n = 7) needed dialysis. Predictors of AKI after SAVR were body mass index (BMI) and intraoperative packed red blood cells (PRBC) transfusion. AKIR patients had a more complicated postoperative course and higher cumulative mortality (25% vs. 17%, p = 0.012) with a median follow-up of 4.1 years. AKI was not found to be an independent predictor of mortality. Conclusions Predictors of AKI after SAVR are increased BMI and intraoperative PRBC transfusion. AKI conferred an increase in hospital length of stay and cumulative mortality while the need for postoperative dialysis was associated with the most complicated hospital stays and the highest in-hospital and cumulative mortalities; therefore careful recognition of patients at risk of AKI is warranted for a better preoperative renal optimization. However, incidence of AKI was lower than what is reported after both on-CPB cardiac surgeries and transcatheter aortic valve replacement, moreover AKI was not found to be an independent predictor of mortality.

Mitral and aortic valve surgery-related acute kidney injury: affecting factors and its one year follow-up

“…[3] Patients with AKI in the postoperative period have a higher infection and sepsis rate with longer intensive care unit stay and higher mortality rate, while they need more intra-aortic balloon pump and inotropic support. [19,[22][23][24][25] Consistent with the previous findings, we found higher sepsis and postoperative atrial fibrillation rates in AKI (+) patients. Our patients with AKI also needed more intra-aortic balloon pump and renal replacement therapy during the postoperative course.…”

“…Considering the comorbidities, there is a number of studies showing that diabetes mellitus, chronic obstructive pulmonary disease, high body mass index, congestive heart failure, and cardiopulmonary bypass time are important factors for AKI development. [16,19] In our study, we found a higher rate of diabetes mellitus in AKI (+) group with an older age. Other preoperative comorbidities were not related with AKI in our study.…”

“…The authors reported the AKI risk to be 46%. In another study, Najjar et al [19] investigated a total of 2,169 patients who underwent aortic valve replacement. In their study population, AKI occurred in 8.5% of patients (stage 1: 67%; stage 2: 23%; stage 3: 10%).…”

“…These results are also consistent with the literature data. [16,17,19] Furthermore, cardiac surgery and cardiopulmonary bypass are significant factors which increase inflammatory activity due to artificial surface and ischemia reperfusion injury. [20] In patients with other active organic problems in addition to this inflammatory activity, such as AKI, lung injury, or sepsis and in patients with a high blood transfusion rate, prolonged ventilation time, and re-exploration in the postoperative period, postoperative morbidity and mortality increase.…”

Pros and cons of transcatheter aortic valve implantation (TAVI)

“…Predictors of AKI in SAVR are mainly BMI and intraprocedural transfusion (50). PARTNER, PARTNER 2A, and SURTAVI trials showed a marked lower rate of AKI in TAVR compared to SAVR at 30-day follow-up (1.3 vs. 3.1, P=0.006; 6 vs. 15.1, P<0.001 and 1.7 vs. 4.4, 95% CI: −4.4 to −1.0 respectively) that was maintained at 1 and 2-year follow-up (13,14,19).…”