Transcatheter vs. surgical aortic valve replacement in patients with aortic stenosis and chronic kidney disease: a comprehensive meta-analysis.

Abstract

Introduction: Aortic stenosis (AS) is treated with either transcatheter aortic valve replacement (TAVR) or Surgical aortic valve replacement (SAVR). However, limited data exist to study the postoperative clinical outcomes in patients with AS and chronic kidney disease (CKD). The objective of this study is to compare TAVR and SAVR postoperative clinical outcomes in patients with AS and CKD.

Methods: According to PRISMA guidelines, a comprehensive search was conducted across various databases such as PubMed, EMBASE, Scopus, and Google Scholar. Original studies that compared the clinical outcomes between TAVR and SAVR in patients with underlying CKD were included in the study.

Results: Twenty-three studies with 69 017 patients with chronic kidney disease who underwent TAVR or SAVR were included in this study. Patients who underwent TAVR had significantly lower odds of in-hospital mortality (OR 0.54; 0.32, 0.91; P = 0.02), acute kidney injury [AKI] (OR 0.41; 0.33, 0.51; P < 0.00001), AKI requiring dialysis (OR 0.66; 0.48, 0.91; P = 0.01), and postoperative complications (OR 0.34; 0.23, 0.50; p<0.0001). However, patients who underwent TAVR had significantly higher odds of permanent pacemaker implantation [PPI] (OR 2.69; 1.96, 3.69; P < 0.0001), major vascular complications (OR 2.56; 1.09, 5.99; P = 0.03).

Conclusion: In patients with AS and CKD, TAVR is associated with significantly lower in-hospital mortality, a reduced incidence of acute kidney injury, and fewer postoperative complications compared to SAVR. However, TAVR carries higher risks of pacemaker implantation and major vascular complications, highlighting the importance of individualized risk assessment and considering TAVR as a favorable alternative to SAVR in appropriately selected CKD patients.