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

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

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