Comprehensive analysis of acute kidney injury incidence following transcatheter versus surgical aortic valve replacement in aortic stenosis: a systematic review and meta-analysis of 13,777 patients.

Abstract

This systematic review and meta-analysis evaluate Acute Kidney Injury (AKI) differences between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) and how surgical risk stratification and diagnostic criteria influence outcomes. Following the PRISMA guidelines, we included both non-randomized studies and randomized clinical trials that reported AKI criteria and patients' surgical risk in patients with aortic stenosis by searching PubMed, Scopus, and Web of Science until late September. We executed a random-effects model in Review Manager to pool effect estimates of AKI incidence or the need for dialysis as an odds ratio (OR) and I² heterogeneity, and we utilized R for meta-regression to address any heterogeneity with subgroup analysis for surgical risk, AKI criteria, and study design. We used the Newcastle Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool (RoB-1) for risk of bias assessment and GRADE for certainty assessment. Involving 17 studies and a total of 13,777 patients, we found that the AKI incidence was significantly lower in TAVR compared to SAVR (OR = 0.36; 95% CI: [0.30, 0.44], I² = 55%, P = 0.003), along with the need for dialysis (OR = 0.35; 95% CI: [0.19, 0.63], I² = 0%, P = 0.92). The study also found that intermediate and low-risk patients had more favorable outcomes. However, the retrospective study design and VARC-2 criteria were associated with unfavorable outcomes. TAVR effectively reduced the risk of AKI in all surgical risk categories and the need for dialysis compared to SAVR in patients with AS.