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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

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

Kuldeep Shah¹, Zakeih Chaker², Tatiana Busu²

¹Division of Cardiology, West Virginia School of Medicine, Morgantown, WV, USA.

Journal of Interventional Cardiology

|November 28, 2019

Summary

Transcatheter aortic valve replacement (TAVR) shows better kidney outcomes than surgical aortic valve replacement (SAVR), with lower acute kidney injury (AKI) rates. Dialysis-requiring AKI rates were similar between TAVR and SAVR, particularly in low-intermediate risk patients.

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Area of Science:

Cardiology
Nephrology
Interventional Cardiology

Background:

Acute kidney injury (AKI) is a significant complication following aortic valve replacement procedures.
Limited comparative data exists on AKI incidence between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).

Purpose of the Study:

To compare the incidence of AKI and dialysis-requiring AKI at 30 days post-procedure between TAVR and SAVR.
To analyze data from randomized controlled trials (RCTs) and propensity-matched observational studies.

Main Methods:

A meta-analysis was conducted on 26 studies, including 20 propensity-matched studies and 6 RCTs, encompassing 19,954 patients.
Incidence of AKI and dialysis-requiring AKI were compared between TAVR and SAVR groups.

Main Results:

Overall AKI incidence was lower after TAVR (7.1%) compared to SAVR (12.1%).
Dialysis-requiring AKI incidence was similar between TAVR (2.8%) and SAVR (4.1%).
In low-intermediate risk patients, TAVR showed significantly lower AKI (7.6% vs. 12.4%) and dialysis-requiring AKI (2.0% vs. 3.6%) rates.

Conclusions:

TAVR is associated with improved renal outcomes at 30 days compared to SAVR, especially in low-to-intermediate risk populations.
Further research is warranted to evaluate the long-term impact of AKI on outcomes for patients undergoing TAVR and SAVR.