Impact of Post-Procedural Acute Kidney Injury in Patients Undergoing Surgical Aortic Valve Replacement Versus Transcatheter Aortic Valve Implantation

Abstract

Aims:The aim was to compare Acute Kidney Injury (AKI) incidence and outcomes among Surgical Aortic Valve Replacement (SAVR) vs Transcatheter Aortic Valve Implantation (TAVI) patients.Methods: Patients undergoing SAVR or TAVI for severe aortic valve stenosis from 09/2017 to 12/2019 were enrolled. The primary endpoint was post-procedural AKI. Main secondary endpoints were AKI at discharge, 30-day and 1-year mortality.Results: 457 patients (SAVR: 201 [44.0%]; TAVI: 256 [56.0%]) were enrolled. The incidence of AKI was higher in the SAVR group (n=58/201 [28.9%] vs 15/256 [5.9%], p<0.001). At discharge, the percentage of AKI patients was higher in the TAVI group (n=8/15 [53.3%] vs 9/58 [15.5%], p<0.001). A significantly higher 30-day and 1-year mortality were recorded among AKI vs no-AKI patients in both groups (30-day mortality: n=5/58 [8.6%] vs 1/143 [0.7%], p=0.01 for SAVR; n=3/15 [20.0%] vs 1/241 [0.4%], p<0.001 for TAVI. 1-year mortality: n=8/58 [13.8%] vs 5/143 [3.5%], p=0.01 for SAVR; n=5/15 [33.3%] vs 21/241 [8.7%], p=0.02 for TAVI). In the SAVR group, the Kaplan-Meier 1-year survival estimate was 96.5% for no-AKI patients and 67.0% for AKI III patients (log-rank p<0.001). In the TAVI group, it was 91.5% for no-AKI patients and 16.5% for AKI III patients (log-rank p<0.001).Conclusions: AKI is a risk factor for 30-day and 1-year mortality in both SAVR and TAVI patients. Despite the higher AKI incidence in SAVR patients, it lasted longer in TAVI patients. TAVI patients with severe AKI had a lower estimate 1-year survival compared to SAVR patients in the same category.

The influence of gender on outcomes following transcatheter aortic valve implantation

“…The prevalence of severe AS requiring intervention is constantly increasing as the size of the elderly population increases ( 14 , 15 ). Consequently, the interest in the most appropriate approach for each patient has rapidly grown, and particularly attention has been given to gender differences.…”