Transcatheter versus Surgical Aortic Valve Replacement in Patients with Moderate to Severe Chronic Kidney Disease: A Systematic Review and Analysis

<p><b>Background:</b> Patients with chronic kidney disease (CKD) and aortic stenosis (AS) have poor prognosis after both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). The objective of our study was to assess the outcomes of TAVR versus SAVR for severe AS among patients with moderate to severe CKD (stage ≥3).</p> <p><b>Methods:</b> PubMed, Cochrane Center Register of Controlled Trials and clinical trial registry were searched through April 2017. Seven studies comparing TAVR (<i>n</i> = 878) and SAVR (<i>n</i> = 2531) in patients with CKD stage ≥3 were included. End points were clinical and qualitative outcomes. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) was computed and <i>p</i> < 0.05 was considered significant.</p> <p><b>Results:</b> There was no difference in all-cause mortality (<i>p</i> = 0.7), cerebrovascular accidents (<i>p</i> = 0.28), myocardial infarction (<i>p</i> = 0.55) or new permanent pacemaker placement (<i>p</i> = 0.06) with TAVR compared with SAVR. Post-procedural worsening renal failure or acute kidney injury (AKI), new dialysis and length of intensive care unit stay were lower with TAVR compared with SAVR (OR:0.47, CI:0.33–0.68, <i>p</i> < 0.0001; OR:0.44, CI:0.25–0.74, <i>p</i> = 0.002 and MD: −68.32 hours, CI: −86.35 to −50.28 hours, <i>p</i> < 0.00001 respectively). Major vascular complications were higher and red blood cell transfusion was lower with TAVR compared with SAVR (OR:8.84, CI:1.6–49, <i>p</i> = 0.01 and OR:0.39, CI:0.18–0.82, <i>p</i> = 0.01 respectively).</p> <p><b>Conclusion:</b> The results of our meta-analysis comparing TAVR with SAVR in patients with severe AS and moderate to severe CKD suggest that TAVR is comparable to SAVR with the advantage of a decreased incidence of worsening of renal failure or AKI, new dialysis, and intensive care unit stay.</p>