Transcatheter versus surgical aortic valve replacement in aortic stenosis patients with advanced chronic kidney disease: a systematic review and meta-analysis

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has been increasingly used in all levels of risk patients, which is less invasive and has fewer complications. However, the benefits of transcatheter and surgical methods of aortic valve replacement remain controversial for aortic stenosis (AS) patients with advanced chronic kidney disease (stage 3-5). Methods: We comprehensively searched PubMed, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) from January 2000 to October 2020 and performed a systematic review to evaluate the two techniques. Two investigators independently conducted the literature searches, study eligibility assessment, and data extraction in duplicate. Results: Compared to surgical aortic valve replacement (SAVR), TAVR had lower risk of in-hospital mortality [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.36–0.78; P=0.001], lower stroke rate (OR: 0.68; 95% CI: 0.47–0.96; P=0.03), lower risk of acute kidney injury (AKI) (OR: 0.42; 95% CI: 0.34–0.52; P<0.00001) and AKI requiring dialysis (OR: 0.65; 95% CI: 0.58–0.73; P<0.00001), lower rate of bleeding (OR: 0.35; 95% CI: 0.31–0.38; P<0.00001) and blood transfusion (OR: 0.41; 95% CI: 0.32–0.52; P<0.00001), lower infection rate (OR: 0.23; 95% CI: 0.13–0.38; P<0.00001), lower risk of atrial fibrillation (AF) (OR: 0.37; 95% CI: 0.17–0.79; P=0.01) and cardiac tamponade (OR: 0.53; 95% CI: 0.37–0.75; P=0.0003), shorter ICU stay [weighted mean difference (WMD): −2.55; 95% CI: −4.13 to −0.98; P=0.002] and hospital stay (WMD: −7.06; 95% CI: −8.41 to −5.71; P<0.00001). Discussion: TAVR is a safe, efficient, and feasible technique for AS patients with advanced CKD and probably a better solution for its advantage in reducing in-hospital mortality, postoperative complications, ICU, and hospital stay.