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

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.

Renal function changes associated with transcatheter aortic valve-in-valve for prosthetic regurgitation compared to stenosis

“…Another important observation of this study is that VIV TAVR, regardless of mechanism of bioprosthetic dysfunction, is associated with a low risk of worsening renal function regardless of baseline CKD stage. This finding is concordant with published data showing low risk of acute kidney injury in conventional TAVR for treatment of native aortic valve stenosis [13] . Distinct changes in renal function following VIV TAVR occurred between the two groups in our study.…”

Effect of TAVR Approach and Other Baseline Factors on the Incidence of Acute Kidney Injury: A Systematic Review and Meta-Analysis

“…Multiple systematic reviews and meta-analyses, [10][11][12][13][14]22] have confirmed that TAVR is associated with a significantly lower risk of AKI than SAVR. Still, no recent meta-analysis in the last three years evaluated the risk of developing AKI post-TAVR in different approaches to our knowledge.…”

“…AKI after TAVR was one of the "big 5" complications identified in the landmark PARTNER trials [7][8][9]. Multiple meta-analyses have confirmed that TAVR is associated with a significantly lower AKI risk than SAVR [10][11][12][13][14]. Still, no recent meta-analysis in the last three years evaluated the risk of developing AKI post-TAVR based on differences in TAVR approaches.…”

Acute Kidney Injury in Patients With Normal Renal Function Undergoing Transcatheter or Surgical Aortic Valve Replacement: Should We Be Concerned?

“…7 AKI is a common complication after both SAVR and TAVR, having an incidence of approximately 12% and 7%, respectively. 8 The rate of AKI requiring dialysis is approximately 3% to 4% for both TAVR and SAVR, with higher figures generally being associated with SAVR. 8 AKI is linked to higher risk of in-hospital mortality and increased length of stay and costs following both SAVR and TAVR.…”

“…8 The rate of AKI requiring dialysis is approximately 3% to 4% for both TAVR and SAVR, with higher figures generally being associated with SAVR. 8 AKI is linked to higher risk of in-hospital mortality and increased length of stay and costs following both SAVR and TAVR. 7 Several patient-and procedural-related factors are implicated in the pathophysiology of AKI during SAVR and TAVR (Fig.…”