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Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Chronic Kidney Disease: A Meta-Analysis

Xiaocheng Cheng1, Qiongwen Hu2, Hanru Zhao3

  • 1Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Journal of Cardiothoracic and Vascular Anesthesia
|January 16, 2019
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) shows lower early mortality and stroke risk compared to surgical aortic valve replacement (SAVR) in chronic kidney disease (CKD) patients. TAVR also reduces acute kidney injury and transfusion needs, making it a potentially preferred option for CKD patients.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Interventional Cardiology

Background:

  • Chronic kidney disease (CKD) is a significant comorbidity in patients undergoing aortic valve replacement.
  • Both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are established treatments for aortic valve stenosis.
  • The comparative clinical outcomes of TAVR versus SAVR in the specific population of patients with CKD remain incompletely understood.

Purpose of the Study:

  • To conduct a meta-analysis comparing the clinical outcomes of TAVR and SAVR.
  • To specifically evaluate these outcomes in patients diagnosed with chronic kidney disease (CKD).
  • To assess risks of mortality, stroke, and other complications between TAVR and SAVR in CKD patients.

Main Methods:

  • A meta-analysis was performed on 10 observational cohort studies.
  • Data were sourced from Medline, Cochrane Library, and Embase databases, covering publications from January 2000 to October 2018.
  • Included were 9,619 patients with CKD undergoing aortic valve replacement; random-effects modeling was used for pooled analysis.

Main Results:

  • TAVR was associated with significantly lower early all-cause mortality (6.1% vs. 10.2%) and postoperative stroke (1.1% vs. 2.2%) compared to SAVR.
  • TAVR demonstrated reduced risks of blood transfusion, infection, and acute kidney injury (AKI), including AKI requiring dialysis.
  • Increased pacemaker implantation rates were observed with TAVR, but no significant differences in cardiac tamponade or major vascular damage were found.

Conclusions:

  • Transcatheter aortic valve replacement (TAVR) may represent a preferable treatment strategy over surgical aortic valve replacement (SAVR) for patients with chronic kidney disease (CKD).
  • The findings suggest potential benefits of TAVR in reducing key adverse events in this vulnerable patient group.
  • A large, prospective, randomized controlled trial is recommended to definitively establish the superiority of TAVR in CKD patients.
Abstract

Keywords:
chronic kidney diseasemeta-analysismortalitystrokesurgical aortic valve replacementtranscatheter aortic valve replacement

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