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Thorac Cardiovasc Surg
DOI: 10.1055/a-2493-1495
Original Cardiovascular

Renal Function After Combined Treatment for Coronary Disease and Aortic Valve Replacement

Zulfugar T. Taghiyev 
1   Department of Cardiovascular Surgery, Justus-Liebig-University, Giessen, Germany
,
Katharina E. Jäger
1   Department of Cardiovascular Surgery, Justus-Liebig-University, Giessen, Germany
,
Martin V. Fuchs
1   Department of Cardiovascular Surgery, Justus-Liebig-University, Giessen, Germany
,
Peter Roth 
1   Department of Cardiovascular Surgery, Justus-Liebig-University, Giessen, Germany
,
Oliver Dörr
2   Department of Cardiology, Justus-Liebig-University, Giessen, Germany
,
Andreas Böning
1   Department of Cardiovascular Surgery, Justus-Liebig-University, Giessen, Germany
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Abstract

Objectives A single-center retrospective study was initialized to investigate the occurrence of acute kidney injury (AKI) and its impact on short- and long-term outcomes after aortic valve replacement in patients with aortic stenosis (AS) and complex coronary artery disease (CAD).

Methods Between January 2010 and December 2020, 1,232 patients with severe AS and CAD were treated. Propensity score matching generated 40 patient pairs with intermediate Society of Thoracic Surgeons (STS) risk scores (3.2 ± 0.3) and EuroSCORE II (4.1 ± 0.3) undergoing percutaneous (transcatheter aortic valve replacement [TAVR] + percutaneous coronary intervention [PCI]) or surgical (surgical aortic valve replacement [SAVR] + coronary artery bypass grafting [CABG]) combined procedures. The renal function-corrected ratio of contrast medium to body weight was calculated to determine the risk of postprocedural contrast medium-associated AKI. Renal retention values were recorded daily until the 7th day after the procedure.

Results The overall incidence of postprocedural AKI was similar between the groups. There was no correlation between the contrast medium volume to serum creatinine to body weight ratio and AKI occurrence. During the first 7 postprocedural days, creatinine clearance values were comparable: 68.97 ± 4.92 mL/min (SAVR + CABG) vs. 64.95 ± 9.78 mL/min (TAVR + PCI), mean difference 4.02, 95% CI (−24.5 to 16.4), p = 0.691. On the 7th day after the procedure, 35% (8/23) of patients with renal impairment had improved renal function. No correlation between impaired renal function and short- or long-term mortality was found in multivariable models.

Conclusion Contrast agents may temporarily impair renal function during a minimally invasive percutaneous approach; however, occurrence of AKI was not related to the amount of contrast medium, and AKI was not associated with short- and long-term mortality.

Keywords

TAVR PCI - SAVR CABG - renal failure - kidney injury

Note

This study was presented at the 52nd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery (on February 12, 2023, DGTHG-V23).


Ethical Approval Statement

Ethics Committee of the Justus Liebig University Giessen -Reg. No.: GI AZ 292/20.


Authors' Contribution

Z.T.T.: Conceptualization; Data collection and curation; Investigation; Methodology; Supervision; Validation; Visualization; Formal analysis; Writing—original draft. M.V.F.: Data—collection, validation, and curation. K.E.J.: Data—collection, validation, and curation. O.D.: Review and editing. P.R.: Supervision; Conceptualization; Writing—review and editing. A.B.: Administration; Data curation; Data validation; Writing—review and editing.


Data Availability Statement

The data underlying this manuscript will be shared by the corresponding author upon reasonable request.




Publication History

Received: 20 September 2024

Accepted: 27 November 2024

Accepted Manuscript online:
29 November 2024

Article published online:
09 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Patterson T, Clayton T, Dodd M. et al; ACTIVATION Trial Investigators. ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter aortic VAlve implantaTION): a randomized clinical trial. JACC Cardiovasc Interv 2021; 14 (18) 1965-1974
    CrossrefPubMedSearch in Google Scholar
  • 2 Costa G, Marinho V, Costa M. et al. Meta-analysis comparing outcomes in patients undergoing transcatheter aortic valve implantation with versus without percutaneous coronary intervention. Eur Heart J 2022; 43 (Suppl 2): ehac544.1590
    CrossrefPubMedSearch in Google Scholar
  • 3 Tarantini G, Tang G, Nai Fovino L. et al. Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions in collaboration with the ESC Working Group on Cardiovascular Surgery. EuroIntervention 2023; 19 (01) 37-52
    CrossrefPubMedSearch in Google Scholar
  • 4 Bagur R, Webb JG, Nietlispach F. et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 2010; 31 (07) 865-874
    CrossrefPubMedSearch in Google Scholar
  • 5 Liao YB, Deng XX, Meng Y. et al. Predictors and outcome of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis. EuroIntervention 2017; 12 (17) 2067-2074
    CrossrefPubMedSearch in Google Scholar
  • 6 Gargiulo G, Capodanno D, Sannino A. et al. Moderate and severe preoperative chronic kidney disease worsen clinical outcomes after transcatheter aortic valve implantation: meta-analysis of 4992 patients. Circ Cardiovasc Interv 2015; 8 (02) e002220
    CrossrefPubMedSearch in Google Scholar
  • 7 Ram P, Mezue K, Pressman G, Rangaswami J. Acute kidney injury post-transcatheter aortic valve replacement. Clin Cardiol 2017; 40 (12) 1357-1362
    CrossrefPubMedSearch in Google Scholar
  • 8 Najjar M, Salna M, George I. Acute kidney injury after aortic valve replacement: incidence, risk factors and outcomes. Expert Rev Cardiovasc Ther 2015; 13 (03) 301-316
    CrossrefPubMedSearch in Google Scholar
  • 9 Généreux P, Kodali SK, Green P. et al. Incidence and effect of acute kidney injury after transcatheter aortic valve replacement using the new valve academic research consortium criteria. Am J Cardiol 2013; 111 (01) 100-105
    CrossrefPubMedSearch in Google Scholar
  • 10 Khawaja MZ, Thomas M, Joshi A. et al. The effects of VARC-defined acute kidney injury after transcatheter aortic valve implantation (TAVI) using the Edwards bioprosthesis. EuroIntervention 2012; 8 (05) 563-570
    CrossrefPubMedSearch in Google Scholar
  • 11 Sinning JM, Ghanem A, Steinhäuser H. et al. Renal function as predictor of mortality in patients after percutaneous transcatheter aortic valve implantation. JACC Cardiovasc Interv 2010; 3 (11) 1141-1149
    CrossrefPubMedSearch in Google Scholar
  • 12 Reardon MJ, Van Mieghem NM, Popma JJ. et al; SURTAVI Investigators. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017; 376 (14) 1321-1331
    CrossrefPubMedSearch in Google Scholar
  • 13 D'Errigo P, Moretti C, D'Ascenzo F. et al; OBSERVANT Research Group. Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in patients with chronic kidney disease stages 3b to 5. Ann Thorac Surg 2016; 102 (02) 540-547
    CrossrefPubMedSearch in Google Scholar
  • 14 Moriyama N, Laakso T, Raivio P. et al. Acute kidney injury following aortic valve replacement in patients without chronic kidney disease. Can J Cardiol 2021; 37 (01) 37-46
    CrossrefPubMedSearch in Google Scholar
  • 15 Baumgartner H, Hung J, Bermejo J. et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2017; 18 (03) 254-275
    CrossrefPubMedSearch in Google Scholar
  • 16 Ong AT, Serruys PW, Mohr FW. et al. The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: design, rationale, and run-in phase. Am Heart J 2006; 151 (06) 1194-1204
    CrossrefPubMedSearch in Google Scholar
  • 17 Roques F, Nashef SA, Michel P. et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999; 15 (06) 816-822 , discussion 822–823
    CrossrefPubMedSearch in Google Scholar
  • 18 Roques F, Michel P, Goldstone AR, Nashef SA. The logistic EuroSCORE. Eur Heart J 2003; 24 (09) 881-882
    CrossrefPubMedSearch in Google Scholar
  • 19 The Society of Thoracic Surgeons. Executive Summary: Society of Thoracic Surgeons Spring 2007 Report. Chicago:: The Society of Thoracic Surgeons;; 2007
    Search in Google Scholar
  • 20 Généreux P, Piazza N, Alu MC. et al; VARC-3 WRITING COMMITTEE. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J 2021; 42 (19) 1825-1857
    CrossrefPubMedSearch in Google Scholar
  • 21 Mehta RL, Kellum JA, Shah SV. et al; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (02) R31
    CrossrefPubMedSearch in Google Scholar
  • 22 Levey AS, Coresh J, Greene T. et al; Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145 (04) 247-254 Erratum in: Ann Intern Med. 2008 Oct 7;149(7):519. Erratum in: Ann Intern Med. 2021 Apr;174(4):584
    CrossrefPubMedSearch in Google Scholar
  • 23 Gowda S, Desai PB, Kulkarni SS, Hull VV, Math AA, Vernekar SN. Markers of renal function tests. N Am J Med Sci 2010; 2 (04) 170-173
    PubMedSearch in Google Scholar
  • 24 Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron J 1976; 16 (01) 31-41
    CrossrefPubMedSearch in Google Scholar