Advanced chronic kidney disease: Relationship to outcomes post‐TAVR, a meta‐analysis

Abstract

Chronic kidney disease (CKD) is associated with worse outcomes in high-surgical-risk patients undergoing transcatheter aortic valve replacement (TAVR). However, it is unclear whether this relationship is apparent in lower-surgical-risk patients. We sought to analyze existing literature to assess whether or not advanced CKD is associated with increased mortality or a greater incidence of adverse events (specifically major stroke, bleeding, and vascular complications). We searched PubMed and Embase (2008-2017) for relevant studies. Studies with <1 year follow-up and those not evaluating advanced CKD or outcomes post-TAVR were excluded. Our co-primary endpoints were the incidence of short-term mortality (defined as in-hospital or 30-day mortality) and long-term mortality (1 year). Our secondary endpoints included incidence of major stroke, life-threatening bleeding, and major vascular complications. Eleven observational studies with a total population of 10709 patients met the selection criteria. Among patients with CKD there was an increased risk of short- and long-term mortality in high-surgical-risk patients who underwent TAVR (hazard ratio [HR]: 1.51, 95% confidence interval [CI]: 1.22-1.88 and HR: 1.56, 95% CI: 1.38-1.77, respectively; P < 0.01). However, there was no association between CKD and mortality in low- to intermediate-risk patients (HR: 1.35, 95% CI: 0.98-1.84, P = 0.06 in short-term and HR: 1.08, 95% CI: 0.92-1.27, P = 0.34 in long-term). In low- to intermediate-risk TAVR patients, advanced CKD is not associated with increased mortality or poorer safety outcomes. These findings should be factored into the clinical decision-making process regarding TAVR candidacy.

Long‑term outcomes of transcatheter self-expanding aortic valve implantations in inoperable and high surgical–risk patients with severe aortic stenosis: a single-center single-valve registry

“…Based on the multivariable Cox analysis, we identified several baseline and procedurerelated factors as being independently associated with long-term mortality after TAVI (Table 4). Most of them are well known and have been previously described [16][17][18][19][20]. Interestingly, we found that balloon postdilatation was the independent predictor of long-term survival (HR 0.35; 95%CI: 0.16 -0.75; P = 0.008).…”

Interaction between severe chronic kidney disease and acute kidney injury in predicting mortality after transcatheter aortic valve implantation: Insights from the Italian Clinical Service Project

“…Several studies showed the association between severe or advanced CKD and increased mortality in patients undergoing TAVI. 5,7,[20][21][22] The role of AKI in predicting early and long-term outcomes among TAVI recipients has been also extensively reported. 10,17,18,23 Mortality rates at 30 days post-TAVI among patients experiencing AKI ranged from 10 to 30% compared with 2 to 15% for patients without AKI.…”

<p>Acute kidney injury after transcatheter aortic valve replacement in the elderly: outcomes and risk management</p>

“…This raises a question about the real benefit from TAVR in this population. Intermediate-risk patients also benefit from TAVR in terms of lower AKI burden when compared to SAVR patients, but their advanced-stage CKD (>4) does not seem to be related to mortality 23…”