TAVR was associated with significantly lower odds of in-hospital mortality compared to SAVR in patients with severe aortic stenosis and CKD on dialysis (OR 0.49; 95% CI 0.29-0.84; p=0.01).
Meta-Analysis (n=28,625)
Does TAVR improve postoperative clinical outcomes compared to SAVR in patients with severe AS and CKD undergoing dialysis?
In patients with severe AS and CKD on dialysis, TAVR is associated with lower in-hospital mortality and shorter length of stay compared to SAVR, despite a higher risk of permanent pacemaker implantation.
Odds Ratio: 0.49 (95% CI 0.29–0.84)
p-value: p=0.01
Background Patients with chronic kidney disease (CKD) undergoing dialysis who also suffer from severe aortic stenosis (AS) present a complex management challenge. Both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are treatment options, but comparative outcomes in this specific, high‐risk population continue to remain unclear. Aim This study aims to compare TAVR and SAVR postoperative clinical outcomes in patients with severe AS and CKD undergoing dialysis. 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 severe AS and CKD undergoing dialysis were included in the study. Results Ten studies, all retrospective, involving 28,625 (14,625 TAVR and 14,000 SAVR) patients with severe AS and CKD undergoing dialysis who underwent TAVR or SAVR were included in this study. Patients who underwent TAVR had significantly lower odds of in‐hospital mortality (OR 0.49; 0.29, 0.84; p = 0.01) and shorter length of stay (LOS) (SMD −2.59; 95% CI −5.04, −0.14; p ≤ 0.04). However, the TAVR group had significantly higher odds of permanent pacemaker implantation (OR 2.25; 95% CI 1.71–2.94; p < 0.00001). Conclusion In patients with severe AS and CKD undergoing dialysis, TAVR is associated with lower in‐hospital mortality and shorter LOS, suggesting a favorable early safety profile and recovery in this population.
Mylavarapu et al. (Thu,) conducted a meta-analysis in Severe aortic stenosis and chronic kidney disease undergoing dialysis (n=28,625). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on in-hospital mortality (OR 0.49, 95% CI 0.29-0.84, p=0.01). TAVR was associated with significantly lower odds of in-hospital mortality compared to SAVR in patients with severe aortic stenosis and CKD on dialysis (OR 0.49; 95% CI 0.29-0.84; p=0.01).