Key result
In patients with advanced chronic kidney disease, surgical aortic valve replacement was associated with a significantly higher risk of postprocedural acute kidney injury compared to transcatheter aortic valve replacement (24.3% vs 7.8%; OR 5.63).
Why the study?
To evaluate the impact of surgical versus transcatheter aortic valve replacement on post-procedural acute kidney injury and other clinical outcomes in patients with advanced chronic kidney disease.
Does TAVR reduce postprocedural acute kidney injury compared to SAVR in patients with advanced chronic kidney disease?
Cohort (n=147)
No
Does TAVR reduce postprocedural acute kidney injury compared to SAVR in patients with advanced chronic kidney disease?
Odds Ratio: 5.63 (95% CI 1.85–17.73)
Absolute Event Rate: 24.3% vs 7.8%
p-value: p=0.002
In patients with advanced chronic kidney disease, TAVR is associated with a significantly lower risk of postprocedural acute kidney injury compared to SAVR.
TAVR may lower AKI risk versus SAVR in advanced CKD; hypothesis-generating and should not yet change practice.
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.
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Kim et al. (2022) conducted a cohort in Aortic stenosis with advanced chronic kidney disease (n=147). Surgical aortic valve replacement (SAVR) vs. Transcatheter aortic valve replacement (TAVR) was evaluated on Postprocedural acute kidney injury (AKI) within 7 days (OR 5.63, 95% CI 1.85-17.73, p=0.002). In patients with advanced chronic kidney disease, surgical aortic valve replacement was associated with a significantly higher risk of postprocedural acute kidney injury compared to transcatheter aortic valve replacement (24.3% vs 7.8%; OR 5.63).
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