Abstract

Acute kidney injury (AKI) is a common postoperative complication after transcatheter aortic valve replacement (TAVR). In patients with ineligible femoral access, transaxillary/subclavian (TAx/TSc) might be competitive alternative access. With nine cohort studies and 4995 patients, we found that TAx/TSc access was associated with decreased incidences of AKI (Relative risk [RR]: 0.573, 95% confidence interval [CI]:0.456−0.718, p < .001) and stage 3 AKI (RR 0.460, 95%CI 0.318−0.665, p < .001) by comparison with intrathoracic approaches. Our findings suggest that TAx/TSc is associated with a reduced AKI risk after TAVR in patients with impossible femoral access.

摘要

急性肾损伤（AKI）是经导管主动脉瓣置换术（TAVR）后常见的术后并发症。对于不符合股骨通路的患者，经腋窝/锁骨下通路 (TAx/TSc) 可能是有竞争力的替代通路。通过 9 项队列研究和 4995 名患者，我们发现 TAx/TSc 通路与 AKI 发生率降低相关（相对风险 [RR]：0.573，95% 置信区间 [CI]：0.456-0.718，p  < .001）和分期3 AKI（RR 0.460，95%CI 0.318-0.665，p  < .001）与胸腔内入路比较。我们的研究结果表明，对于无法进入股骨的患者，TAx/TSc 与 TAVR 后 AKI 风险降低相关。