李练,方臻飞

• 1:中南大学湘雅二医院心血管内科

摘要(Abstract)：

经导管主动脉瓣置换术（TAVR）目前是老年主动脉瓣狭窄（AS）患者的一线治疗方式，较外科主动脉瓣置换术（SAVR）的病死率及并发症的发生率低，但由于TAVR术中使用对比剂、低灌注、输血、麻醉及胆固醇栓塞等因素，导致急性肾损伤（AKI）风险增加，影响患者预后。本文就TAVR围术期AKI的危险因素及预防措施的国内外相关报道进行综述，旨在降低TAVR围术期AKI的发生率以改善患者预后并提高生活质量。

关键词(KeyWords)： 经导管主动脉瓣置换术;主动脉瓣狭窄;肾功能不全;危险因素;预防

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李练,方臻飞

参考文献(References)：

• [1] Pibarot P, Salaun E, Dahou A, et al. Echocardiographic results of transcatheter versus surgical aortic valve replacement in low-risk patients:the PARTNER 3 trial[J]. Circulation,2020, 141(19):1527-1537.
• [2] Miura D, Yamada Y, Kusaba S, et al. Influence of preoperative serum creatinine level and intraoperative volume of contrast medium on the risk of acute kidney injury after transfemoral transcatheter aortic valve implantation:a retrospective observational study[J].BMC Res Notes, 2019, 12(1):484.
• [3] Merchant AM, Neyra JA, Minhajuddin A, et al. Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement[J]. BMC Anesthesiol,2019, 19(1):99.
• [4]中国医师协会心血管内科医师分会结构性心脏病专业委员会，中华医学会心血管病学分会结构性心脏病学组.经导管主动脉瓣置换术中国专家共识（2020更新版）[J].中国介入心脏病学杂志，2020, 28(6):301-309.
• [5] Cubeddu RJ, Asher CR, Lowry AM, et al. Impact of transcatheter aortic valve replacement on severity of chronic kidney disease[J]. J Am Coll Cardiol, 2020, 76(12):1410-1421.
• [6] Thongprayoon C, Cheungpasitporn W, Srivali N, et al. AKI after transcatheter or surgical aortic valve replacement[J]. J Am Soc Nephrol, 2016, 27(6):1854-1860.
• [7] Carroll JD, Mack MJ, Vemulapalli S, et al. STS-ACC TVT registry of transcatheter aortic valve replacement[J]. J Am Coll Cardiol, 2020, 76(21):2492-2516.
• [8] Thongprayoon C, Cheungpasitporn W, Mao MA, et al.Persistent acute kidney injury following transcatheter aortic valve replacement[J]. J Card Surg, 2017, 32(9):550-555.
• [9] Tian Y, Feng S, Zhan Z, et al. Risk factors for new-onset cardiac valve calcification in patients on maintenance peritoneal dialysis[J]. Cardiorenal Med, 2016, 6(2):150-158.
• [10] Adachi Y, Yamamoto M, Shimura T, et al. Late Adverse cardiorenal events of catheter procedure-related acute kidney injury after transcatheter aortic valve implantation[J]. Am J Cardiol, 2020, 133:89-97.
• [11] Bandyopadhyay D, Sartori S, Baber U, et al. The impact of chronic kidney disease in women undergoing transcatheter aortic valve replacement:analysis from the Women’s INternational Transcatheter Aortic valve Implantation(WINTAVI)registry[J]. Catheter Cardiovasc Interv, 2020, 96(1):198-207.
• [12] Weisbord SD, Mor MK, Resnick AL, et al. Incidence and outcomes of contrast-induced AKI following computed tomography[J]. Clin J Am Soc Nephrol, 2008, 3(5):1274-1281.
• [13] Elbadawi A, Naqvi SY, Saad M, et al. In-hospital outcomes with transfemoral versus transapical access for transcatheter aortic valve replacement in patients with peripheral arterial disease[J].Cardiovasc Revasc Med, 2020, 21(5):604-609.
• [14] Villablanca PA, Mohananey D, Nikolic K, et al. Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement:a meta-analysis[J].Catheter Cardiovasc Interv, 2018, 91(2):330-342.
• [15] Li YM, Tsauo JY, Liao YB, et al. Comparison of third generation balloon-expandable Edwards Sapien 3 versus selfexpandable Evolut R in transcatheter aortic valve implantation:a meta-analysis[J]. Ann Palliat Med, 2020, 9(3):700-708.
• [16] Droppa M, Rudolph TK, Baan J, et al. Risk factors for permanent pacemaker implantation in patients receiving a balloonexpandable transcatheter aortic valve prosthesis[J]. Heart Vessels, 2020, 35(12):1735-1745.
• [17] Seeliger E, Lenhard DC, Persson PB. Contrast media viscosity versus osmolality in kidney injury:lessons from animal studies[J].Biomed Res Int, 2014, 2014:358136.
• [18] Généreux P, Piazza N, Alu MC, et al. Valve academic research consortium 3:updated endpoint definitions for aortic valve clinical research[J]. J Am Coll Cardiol, 2021, 77(21):2717-2746.
• [19] Haase M, Bellomo R, Devarajan P, et al. Accuracy of neutrophil gelatinase-associated lipocalin(NGAL)in diagnosis and prognosis in acute kidney injury:a systematic review and meta-analysis[J].Am J Kidney Dis, 2009, 54(6):1012-1024.
• [20] Zaleska-Kociecka M, Skrobisz A, Wojtkowska I, et al. Serum beta-2 microglobulin levels for predicting acute kidney injury complicating aortic valve replacement[J]. Interact Cardiovasc Thorac Surg, 2017, 25(4):533-540.
• [21] Kashani K, Al-Khafaji A, Ardiles T, et al. Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury[J]. Crit Care, 2013, 17(1):R25.
• [22] Koyner J, Bakris G. Kidney injury is not prevented by hydration alone[J]. Eur Heart J, 2019, 40(38):3179-3181.
• [23] Barbanti M, Gulino S, Capranzano P, et al. Acute kidney injury with the renalguard system in patients undergoing transcatheter aortic valve replacement:the protect-tavi trial(prophylactic effect of furosemide-induced diuresis with matched isotonic intravenous hydration in transcatheter aortic valve implantation)[J]. JACC Cardiovasc Interv, 2015, 8(12):1595-1604.
• [24] Davenport MS, Perazella MA, Yee J, et al. Use of intravenous iodinated contrast media in patients with kidney disease:consensus statements from the American college of radiology and the national kidney foundation[J]. Kidney Med, 2020, 2(1):85-93.
• [25] Brar SS, Aharonian V, Mansukhani P, et al. Haemodynamicguided fluid administration for the prevention of contrast-induced acute kidney injury:the POSEIDON randomised controlled trial[J].Lancet, 2014, 383(9931):1814-1823.
• [26] Semler MW, Self WH, Wanderer JP, et al. Balanced crystalloids versus saline in critically Ill adults[J]. N Engl J Med, 2018, 378(9):829-839.
• [27] Spagnolo P, Giglio M, DI Marco D, et al. Feasibility of ultralow contrast 64-slice computed tomography angiography before transcatheter aortic valve implantation:a real-world experience[J].Eur Heart J Cardiovasc Imaging, 2016, 17(1):24-33.
• [28] Rodés-Cabau J, Kahlert P, Neumann FJ, et al. Feasibility and exploratory efficacy evaluation of the Embrella Embolic Deflector system for the prevention of cerebral emboli in patients undergoing transcatheter aortic valve replacement:the PROTAVI-C pilot study[J]. JACC Cardiovasc Interv, 2014, 7(10):1146-1155.
• [29] Ladia V, Panchal HB, O?neil TJ, et al. Incidence of renal failure requiring hemodialysis following transcatheter aortic valve replacement[J]. Am J Med Sci, 2016, 352(3):306-313.
• [30] Weisbord SD, Gallagher M, Jneid H, et al. Outcomes after angiography with sodium bicarbonate and acetylcysteine[J]. N Engl J Med, 2018, 378(7):603-614.
• [31] Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure[J]. N Engl J Med, 2002, 346(5):305-310.
• [32] Najjar M, Salna M, George I. Acute kidney injury after aortic valve replacement:incidence, risk factors and outcomes[J].Expert Rev Cardiovasc Ther, 2015, 13(3):301-316.
• [33] Mehran R, Dangas GD, Weisbord SD. Contrast-associated acute kidney injury[J]. N Engl J Med, 2019, 380(22):2146-2155.
• [34] Bhise V, Kanade P, Shantha GP, et al. Transcatheter and surgical aortic valve replacement in patients with end-stage renal disease[J]. J Am Coll Cardiol, 2017, 69(14):1875-1876.
• [35] Guerraty MA, Chai B, Hsu JY, et al. Relation of aortic valve calcium to chronic kidney disease(from the chronic renal insufficiency cohort study)[J]. Am J Cardiol, 2015, 115(9):1281-1286.