Гостре пошкодження нирок у хворих після протезування аортального клапана: ретроспективне дослідження одного центру

Borys Todurov; Iryna Shifris; Mykhailo Todurov; Oleh Zelenchuk; Serhii  Sudakevych; Stepan Maruniak; Natalia Yaschenko

doi:10.31450/ukrjnd.3(83).2024.10

Borys Todurov SI "Heart Institute of the Ministry of Health of Ukraine", Kyiv, Ukraine https://orcid.org/0009-0000-2047-4447
Iryna Shifris SI "Heart Institute of the Ministry of Health of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0002-9413-7301
Mykhailo Todurov Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine https://orcid.org/0009-0001-9228-2708
Oleh Zelenchuk SI "Heart Institute of the Ministry of Health of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0002-5677-9311
Serhii Sudakevych SI "Heart Institute of the Ministry of Health of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0002-9253-9593
Stepan Maruniak SI "Heart Institute of the Ministry of Health of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0001-7538-2443
Natalia Yaschenko SI "Heart Institute of the Ministry of Health of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0003-3270-0661

DOI: https://doi.org/10.31450/ukrjnd.3(83).2024.10

Keywords: acute kidney injury, aortic stenosis, cardiopulmonary bypass, transcatheter aortic valve implantation.

Abstract

Currently, successful correction of aortic stenosis is achieved using both surgical and transcatheter techniques, each of which carries a risk of various complications, including acute kidney injury (AKI). This study aimed to assess the frequency and predictors of AKI in the postoperative period among patients with aortic valve stenosis, depending on the treatment method used.

Methods. This retrospective study included 126 patients with aortic valve stenosis who received treatment between 2018 and 2022 at the State Institution "Heart Institute of the Ministry of Health of Ukraine." Based on the method of aortic stenosis correction, all patients were divided into two groups: the first group underwent transcatheter aortic valve implantation (TAVI group, n = 47), and the second group underwent aortic valve replacement with a biological prosthesis (BioAVR group, n = 52). The groups were compared based on preoperative, intraoperative, and early postoperative indicators. Acute kidney injury (AKI) was determined using the KDIGO criteria. Statistical analysis of the results was performed using the "MedCalc" program on a personal computer.

Results. Patients who underwent TAVI (Group 1) were significantly older (p=0.002), had a 10.4% lower hemoglobin level (p=0.001), and a higher EuroSCORE II operative risk score (p<0.001) compared to those who underwent aortic valve replacement with a biological prosthesis (Group 2). Patients in Group 1 were 13.28% less likely to develop acute kidney injury in the early postoperative period than those in Group 2 (p=0.033). According to the results of multivariate stepwise Cox analysis, the following independent predictors of AKI in the study cohort were identified with high and reliable predictive values of HR (Hazard Ratio): preoperative serum creatinine, duration of aortic cross-clamping, and the presence of diabetes (model χ² = 24.045, df=3, p<0.0001).

Conclusions: The incidence of AKI in the studied cohort was 9.10% and was more than 7 times higher in the BioAVR group compared to the TAVI group. Independent risk factors for the development of AKI were baseline serum creatinine, duration of aortic cross-clamping, and the presence of diabetes.