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. 2020 Oct;11(5):280-285.
doi: 10.14740/cr1092. Epub 2020 Aug 1.

Transcatheter Versus Surgical Aortic Valve Replacement in Renal Transplant Patients: A Meta-Analysis

Tanveer Mir  1 , Fahed Darmoch  2 , Waqas Ullah  3 , Yasar Sattar  4 , Zaher Hakim  5 , Homam Moussa Pacha  6 , Lina Fouad  7 , Delair Gardi  5 , James J Glazier  5 , Kenton Zehr  5 , M Chadi Alraies  5
Affiliations

Transcatheter Versus Surgical Aortic Valve Replacement in Renal Transplant Patients: A Meta-Analysis

Tanveer Mir et al. Cardiol Res. 2020 Oct.

Abstract

Background: The outcome of transcutaneous aortic valve replacement (TAVR) in patients with kidney transplant is unknown, as majority of these patients were excluded from the major TAVR clinical trials. We sought to compare patients with severe aortic stenosis who underwent TAVR versus surgical aortic valve replacement (SAVR) with a history of kidney transplant.

Methods: PubMed, Google Scholar and Cochrane databases were searched to identify relevant articles. The incidence of all-cause mortality and acute kidney injury (AKI) was calculated using relative risk on a random effect model.

Results: A total of 1,538 patients (TAVR 328, SAVR 1,210) were included in the study. TAVR was associated with lower mortality as compared with SAVR at 30 days from the index procedure (odds ratio (OR) 0.48, 95% confidence interval (CI): 0.25 - 0.93; P = 0.03). One-year mortality was studied in three studies and showed comparable mortality in patients undergoing TAVR and SAVR (OR: 0.76, 95% CI: 0.10 - 5.51; P = 0.78). Compared to SAVR, TAVR carries an identical risk of AKI (OR: 0.44, 95% CI: 0.10 - 1.90; P = 0.27). A sensitivity analysis performed by exclusion of Voudris et al study showed a non-significant difference in the mortality incidence of two groups at 30 days (OR: 0.72, 95% CI: 0.27 - 1.91; P = 0.51).

Conclusions: In patients with a history of kidney transplant, TAVR was associated with a comparable risk of mortality and AKI compared to SAVR.

Keywords: Aortic stenosis; Renal transplant; SAVR; TAVR.

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Conflict of interest statement

None to declare.

Figures

Figure 1
Figure 1
PRISMA flow chart for selection of studies. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
(a) 30-days mortality plot with OR and 95% CI. TAVR has low mortality rates than SAVR. Results were statistically significant. (b) 1-year mortality. TAVR has comparable rates of 1-year mortality as SAVR. OR: odds ratio; CI: confidence interval; TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 3
Figure 3
(a) AKI has comparable results in TAVR and SAVR. (b) Hospital stay, TAVR has better rates than SAVR. AKI: acute kidney injury; TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 4
Figure 4
Funnel plot for bias of study. There is no significant scatter on the funnel plot which relates to less bias in publication.
See this image and copyright information in PMC

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