Key result
Valve-in-valve transcatheter aortic valve replacement significantly reduced the odds of postoperative acute kidney injury (OR 0.45) compared to redo surgical aortic valve replacement.
Why the study?
Postoperative AKI and RRT are common complications after ViV-TAVR and redo SAVR, but the understanding of renal outcomes between these procedures remains controversial.
Does transcatheter valve-in-valve aortic valve replacement reduce acute kidney injury and the need for renal replacement therapy compared to redo surgical aortic valve replacement in patients with failed bioprosthetic aortic valves?
Meta-Analysis (n=11,198)
Yes
Does transcatheter valve-in-valve aortic valve replacement reduce acute kidney injury and the need for renal replacement therapy compared to redo surgical aortic valve replacement in patients with failed bioprosthetic aortic valves?
In patients with failed bioprosthetic aortic valves, ViV-TAVR is associated with a significantly lower risk of postoperative acute kidney injury and need for renal replacement therapy compared to redo SAVR.
ViV-TAVR may lower AKI and RRT risk versus redo SAVR; leaves open need for RCTs before shifting practice.
INTRODUCTION: Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve-in-valve aortic valve replacement (ViV-TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV-TAVR remains controversial. METHODS: A systematic database search with meta-analysis was conducted of comparative original articles of ViV-TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30-day mortality. RESULTS: Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV-TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30-day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV-TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV-TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%). CONCLUSION: Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re-intervention for the aortic valve constitute a high-risk and frail population in which ViV-TAVR demonstrated it might be a feasible option for carefully selected patients. Long-term follow-up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.
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Rad et al. (2022) conducted a meta-analysis in Failed aortic valve bioprosthesis (n=11,198). Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) vs. Redo surgical aortic valve replacement (redo SAVR) was evaluated on Acute kidney injury (AKI) (OR 0.45, 95% CI 0.30-0.69, p=<0.001). Valve-in-valve transcatheter aortic valve replacement significantly reduced the odds of postoperative acute kidney injury (OR 0.45) compared to redo surgical aortic valve replacement.
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