Key result
In patients with aortic stenosis and chronic kidney disease, TAVR significantly lowered in-hospital mortality compared to SAVR (OR 0.54; 95% CI 0.32-0.91; P=0.02).
Why the study?
Limited data exist comparing postoperative clinical outcomes between TAVR and SAVR in patients with aortic stenosis and chronic kidney disease.
Does TAVR reduce in-hospital mortality and complications compared to SAVR in patients with aortic stenosis and chronic kidney disease?
Meta-Analysis (n=69,017)
Does TAVR reduce in-hospital mortality and complications compared to SAVR in patients with aortic stenosis and chronic kidney disease?
Odds Ratio: 0.54 (95% CI 0.32–0.91)
p-value: p=0.02
In patients with aortic stenosis and CKD, TAVR is associated with lower in-hospital mortality and AKI but higher rates of pacemaker implantation and vascular complications compared to SAVR.
May support TAVR as a short-term alternative after individualized assessment in AS-CKD; extends observational data but leaves RCTs and long-term outcomes open.
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.
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Mylavarapu et al. (2025) conducted a meta-analysis in Aortic stenosis and chronic kidney disease (n=69,017). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on in-hospital mortality (OR 0.54, 95% CI 0.32-0.91, p=0.02). In patients with aortic stenosis and chronic kidney disease, TAVR significantly lowered in-hospital mortality compared to SAVR (OR 0.54; 95% CI 0.32-0.91; P=0.02).
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