Transcatheter aortic valve implantation versus surgical aortic valve replacement in chronic kidney disease: Meta-analysis of reconstructed time-to-event data

Background

Patients with advanced chronic kidney disease (CKD) are a challenging and understudied population. Specifically, the late outcomes following surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) in patients with CKD remains uncertain.

Objectives

To compare overall mortality risk in patients with moderate-to-severe CKD following TAVI versus SAVR.

Methods

Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by August 2022.

Results

Nine studies met our inclusion criteria. Patients who underwent TAVI had a higher 5-year mortality compared with patients undergoing SAVR in the overall population (HR 1.56, 95% CI 1.44–1.69, P < 0.001) and in populations with similar risk scores (HR 1.15, 95% CI 1.01–1.31, P = 0.035). The landmark analysis revealed a lower risk of 30-day mortality with TAVI (HR 0.62, 95% CI 0.41–0.94, P = 0.023), followed by similar risk until 7.5 months (HR 1, 95% CI 0.78–1.27, P = 0.978). In contrast, the landmark analysis beyond 7.5 months yielded a reversal of the HR in favor of SAVR (TAVI with HR 1.27, 95% CI 1.08–1.49 P = 0.003).

Conclusions

In patients with CKD, TAVI provides an initial survival benefit over SAVR. However, in the long run, a significant survival benefit of SAVR over TAVI was observed. Our findings highlight the need for randomized controlled trials to investigate outcomes in this special population.