Meta-Analysis comparing outcomes and need for renal replacement therapy of Transcatheter aortic valve implantation versus surgical aortic valve replacement

Document Type

Article

Department

Medical College Pakistan; Cardiology

Abstract

Acute kidney injury (AKI) is commonly associated with aortic valve replacement. Surgical aortic valve replacement (SAVR) is a known risk factor for AKI but little is known about the short- and long-term effects of transcatheter aortic valve implantation (TAVI). The purpose of our analysis is to identify the short- and long-term effect of TAVI on renal out-comes. We searched Medline and PUB MED from January 1, 2000 to November 6, 2017for randomized control trials (RCTs) comparing TAVI to SAVR in patients with severe aortic stenosis. Three hundred sixty-nine trials were identified, 6 RCTs were included in our analysis. RevMan version 5.3 was used for statistical analysis. Heterogeneity is calculated using I2statistics. Primary outcomes were AKI within 30 days and 1 year of TAVI, and requirement for renal replacement therapy. We included 5,536 patients (2,796 inTAVI and 2,740 in SAVR arm) from 6 RCTs. Baseline characteristics were similar. There was reduced incidence of AKI at 30 days of TAVI compared with SAVR, 57 versus 133(odds ratio [OR] 0.40, confidence interval [CI] 0.28 to 0.56, p <0.00001, I2= 7%) with no difference at 1 year (OR 0.65, CI 0.32 to 1.32, p = 0.23, I2= 76%) and need for renal replacement therapy OR 0.95, CI 0.50 to 1.80, p = 0.87, I2= 0%). The permanent pacemaker was more frequent in the TAVI arm compared with SAVR arm, 379 versus 110, (OR 3.75, CI 1.67 to 8.42, p = 0.001, I2= 89%). In conclusion, TAVI is associated with a reduction inAKIs at 30 days despite the exposure to contrast and a higher incidence of new permanent pacemaker placement.

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Publication (Name of Journal)

The Journal of American Cardiology

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