Key result
TAVR cuts post-procedural AKI by ~53% compared to SAVR in advanced CKD.
Why the study?
Patients with moderate to severe chronic kidney disease and severe aortic stenosis have poor prognosis after both TAVR and SAVR, necessitating comparison of outcomes between these treatments.
Does transcatheter aortic valve replacement improve clinical outcomes compared to surgical aortic valve replacement in patients with severe aortic stenosis and moderate to severe chronic kidney disease?
Meta-Analysis (n=3,409)
Does transcatheter aortic valve replacement improve clinical outcomes compared to surgical aortic valve replacement in patients with severe aortic stenosis and moderate to severe chronic kidney disease?
Odds Ratio: 0.47 (95% CI 0.33–0.68)
p-value: p=<0.0001
In patients with severe aortic stenosis and moderate to severe chronic kidney disease, TAVR offers comparable mortality to SAVR but significantly reduces the risk of acute kidney injury and the need for new dialysis.
Supports TAVR preference over SAVR in severe AS with CKD ≥3 to lower AKI risk; extends randomized evidence via meta-analysis.
Background Patients with chronic kidney disease (CKD) and aortic stenosis (AS) have poor prognosis after both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). The objective of our study was to assess the outcomes of TAVR versus SAVR for severe AS among patients with moderate to severe CKD (stage ≥3). Methods PubMed, Cochrane Center Register of Controlled Trials and clinical trial registry were searched through April 2017. Seven studies comparing TAVR ( n = 878) and SAVR ( n = 2531) in patients with CKD stage ≥3 were included. End points were clinical and qualitative outcomes. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) was computed and p < 0.05 was considered significant. Results There was no difference in all-cause mortality ( p = 0.7), cerebrovascular accidents ( p = 0.28), myocardial infarction ( p = 0.55) or new permanent pacemaker placement ( p = 0.06) with TAVR compared with SAVR. Post-procedural worsening renal failure or acute kidney injury (AKI), new dialysis and length of intensive care unit stay were lower with TAVR compared with SAVR (OR:0.47, CI:0.33–0.68, p < 0.0001; OR:0.44, CI:0.25–0.74, p = 0.002 and MD: −68.32 hours, CI: −86.35 to −50.28 hours, p < 0.00001 respectively). Major vascular complications were higher and red blood cell transfusion was lower with TAVR compared with SAVR (OR:8.84, CI:1.6–49, p = 0.01 and OR:0.39, CI:0.18–0.82, p = 0.01 respectively). Conclusion The results of our meta-analysis comparing TAVR with SAVR in patients with severe AS and moderate to severe CKD suggest that TAVR is comparable to SAVR with the advantage of a decreased incidence of worsening of renal failure or AKI, new dialysis, and intensive care unit stay.
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Panchal et al. (2017) conducted a meta-analysis in Severe aortic stenosis and moderate to severe chronic kidney disease (n=3,409). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Post-procedural worsening renal failure or acute kidney injury (AKI) (OR 0.47, 95% CI 0.33-0.68, p=<0.0001). In patients with severe aortic stenosis and CKD stage ≥3, TAVR significantly reduced post-procedural acute kidney injury compared with SAVR (OR 0.47; 95% CI 0.33-0.68; p<0.0001).
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