April 24, 2019Journal of Interventional CardiologyOpen Access

Meta-Analysis Comparing Renal Outcomes after Transcatheter versus Surgical Aortic Valve Replacement

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Why the study?

Acute kidney injury is a common complication of aortic valve replacement, but comparative data on its incidence following TAVR versus SAVR was sparse.

Does transcatheter aortic valve replacement reduce the incidence of acute kidney injury at 30 days compared to surgical aortic valve replacement?

Structured PICO

Does transcatheter aortic valve replacement reduce the incidence of acute kidney injury at 30 days compared to surgical aortic valve replacement?

Population

19,954 patients undergoing aortic valve replacement across 26 studies (20 propensity-matched observational studies and 6 RCTs).

Intervention

Transcatheter aortic valve replacement (TAVR)

Comparator

Surgical aortic valve replacement (SAVR)

Outcome

Incidence of acute kidney injury (AKI) at 30 dayssafety

TAVR is associated with a significantly lower risk of 30-day acute kidney injury compared to SAVR, particularly in patients at low-to-intermediate surgical risk.

Implication

TAVR lowers short-term AKI risk versus SAVR; reinforces RCT evidence while leaving long-term renal impact open for further study.

Abstract

Background. Acute kidney injury (AKI) is a common complication of aortic valve replacement. However, comparative on the incidence of (AKI) following transcatheter (TAVR) versus surgical valve replacement (SAVR) is sparse. Methods. We performed a meta-analysis of the randomized controlled trials (RCT) and propensity-matched observational studies comparing (A) incidence of AKI and (B) incidence of dialysis-requiring AKI at 30 days after TAVR and SAVR. Results. Twenty-six studies (20 propensity-matched studies; 6 RCTs) including 19,954 patients were analyzed. The incidence of AKI was lower after TAVR than after SAVR (7.1% vs. 12.1%, OR 0.52; 95%CI, 0.39-0.68; p<0.001, I2=57%), but the incidence of dialysis-requiring AKI was similar (2.8% vs. 4.1%, OR 0.78; 95%CI, 0.49-1.25; p=0.31, I2=70%). Similar results were observed in a sensitivity analysis including RCTs only for both AKI ([5 RCTs; 5,418 patients], 2.0% vs. 5.0%, OR 0.39; 95%CI, 0.28-0.53; p<0.001, I2=0%), and dialysis-requiring AKI ([2 RCTs; 769 patients]; 2.9% vs. 2.6%, OR 1.1; 95%CI, 0.47-2.58; p=0.83, I2=0%). However, in studies including low-intermediate risk patients only, TAVR was associated with lower incidence of AKI ([10 studies; 6,510 patients], 7.6% vs. 12.4%, OR 0.55, 95%CI 0.39-0.77, p<0.001, I2=57%), and dialysis-requiring AKI, ([10 studies; 12,034 patients], 2.0% vs. 3.6%, OR 0.57, 95%CI 0.38-0.85, p=0.005, I2=23%). Conclusions. TAVR is associated with better renal outcomes at 30 days in comparison with SAVR, especially in patients at low-intermediate surgical risk. Further studies are needed to assess the impact of AKI on long-term outcomes of patients undergoing TAVR and SAVR.