Meta-Analysis Comparing Renal Outcomes after Transcatheter versus Surgical Aortic Valve Replacement. (24th April 2019)

• Record Type: Journal Article
• Authors: Shah, Kuldeep; Chaker, Zakeih; Busu, Tatiana; Shah, Rishita; Osman, Mohammed; Alqahtani, Fahad; Alkhouli, Mohamad
• Other Names: Panoulas Vasileios Academic Editor.
• Is Part Of: Journal of interventional cardiology. Volume 2019(2019)
• Publication Date: 2019-04-24
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.1206
• DOI: 10.1155/2019/3537256
• Languages: English
• ISSNs: 0896-4327

Abstract

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, I 2 =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, I 2 =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, I 2 =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, I 2 =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, I 2 =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, I 2 =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.