Key result
Transfemoral TAVR was associated with a significantly lower risk of acute kidney injury compared to transapical TAVR (9.6% vs 16%; RR 0.49; 95% CI 0.36-0.66; p<0.00001).
Why the study?
Acute kidney injury is a well-known complication after TAVR associated with increased morbidity and mortality, but the comparative risk across different procedural approaches needed evaluation.
Does the transfemoral TAVR approach reduce the incidence of acute kidney injury compared to transapical or transaortic approaches in patients undergoing TAVR?
Meta-Analysis (n=70,406)
Does the transfemoral TAVR approach reduce the incidence of acute kidney injury compared to transapical or transaortic approaches in patients undergoing TAVR?
Relative Risk: 0.49 (95% CI 0.36–0.66)
Absolute Event Rate: 9.6% vs 16%
p-value: p=<0.00001
The transfemoral approach for TAVR is associated with a significantly lower risk of acute kidney injury compared to alternative access routes such as transapical and transaortic.
Supports preferring transfemoral access to lower AKI when feasible; leaves open causal confirmation in randomized trials.
Background. Acute kidney injury (AKI) is a well-known complication following a transcatheter aortic valve replacement (TAVR) and is associated with higher morbidity and mortality. Objective. We aim to compare the risk of developing AKI after transfemoral (TF), transapical (TA), and transaortic (TAo) approaches following TAVR. Methods. We searched Medline and EMBASE databases from January 2009 to January 2021. We included studies that evaluated the risk of AKI based on different TAVR approaches. After extracting each study’s data, we calculated the risk ratio and 95% confidence intervals using RevMan software 5.4. Publication bias was assessed by the forest plot. Results. Thirty-six (36) studies, consisting of 70,406 patients undergoing TAVR were included. Thirty-five studies compared TF to TA, and only seven investigations compared TF to TAo. AKI was documented in 4,857 out of 50,395 (9.6%) patients that underwent TF TAVR compared to 3,155 out of 19,721 (16%) patients who underwent TA-TAVR, with a risk ratio of 0.49 (95% CI, 0.36–0.66; p < 0.00001 ). Likewise, 273 patients developed AKI out of the 1,840 patients (14.8%) that underwent TF-TAVR in contrast to 67 patients out of the 421 patients (15.9%) that underwent TAo-TAVR, with a risk ratio of 0.51 (95% CI, 0.27–0.98; p = 0.04). There was no significant risk when we compared TA to TAo approaches, with a risk ratio of 0.89 (95% CI, 0.29–2.75; p = 0.84). Conclusion. The risk of post-TAVR AKI is significantly lower in patients who underwent TF-TAVR than those who underwent TA-TAVR or TAo-TAVR.
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Alzu’bi et al. (2022) conducted a meta-analysis in Acute kidney injury following TAVR (n=70,406). Transfemoral TAVR vs. Transapical and transaortic TAVR was evaluated on Acute kidney injury (AKI) (RR 0.49, 95% CI 0.36-0.66, p=<0.00001). Transfemoral TAVR was associated with a significantly lower risk of acute kidney injury compared to transapical TAVR (9.6% vs 16%; RR 0.49; 95% CI 0.36-0.66; p<0.00001).
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