Transcatheter aortic valve implantation versus surgical aortic valve replacement in dialysis-dependent patients: a meta-analysis

Abstract

<jats:sec> <jats:title>Objectives</jats:title> <jats:p>This meta-analysis aims to compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) versus aortic valve replacement (AVR) for aortic stenosis in dialysis-dependent patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Literature searches employed PubMed, Web of Science, Google Scholar and Embase to identify relevant studies. Bias-treated data were prioritized, isolated and pooled for analysis; raw data were utilized where bias-treated data were unavailable. Outcomes were analysed to assess for study data crossover.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Literature search identified 10 retrospective studies; following data source analysis, five studies were included. Upon pooling of bias-treated data, TAVI was significantly favoured in early mortality [odds ratio (OR), 0.42; 95% confidence interval (95% CI), 0.19–0.92; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 92%; <jats:italic toggle="yes">P</jats:italic> = 0.03], 1-year mortality (OR, 0.88; 95% CI 0.80–0.97; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 0%; <jats:italic toggle="yes">P</jats:italic> = 0.01), rates of stroke/cerebrovascular events (OR, 0.71; 95% CI 0.55–0.93; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 0%; <jats:italic toggle="yes">P</jats:italic> = 0.01) and blood transfusions (OR, 0.36; 95% CI 0.21–0.62; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 86%; <jats:italic toggle="yes">P</jats:italic> = 0.0002). Pooling demonstrated fewer new pacemaker implantations in the AVR group (OR, 3.33; 95% CI 1.94–5.73; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 74%; <jats:italic toggle="yes">P</jats:italic> ≤ 0.0001) and no difference in the rate of vascular complications (OR, 2.27; 95% CI 0.60–8.59; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 83%; <jats:italic toggle="yes">P</jats:italic> = 0.23). Analysis including raw data revealed the length of hospital stay to favour TAVI with a mean difference of –9.20 days (95% CI –15.58 to –2.82; <jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 97%; <jats:italic toggle="yes">P</jats:italic> = 0.005).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Bias-treated meta-analysis comparing surgical AVR and TAVI favoured TAVI in early mortality, 1-year mortality, rates of stroke/cerebrovascular events and blood transfusions. There was no difference in the rates of vascular complications; however, TAVI required more pacemaker implantations. Data pooling including raw data revealed that the length of hospital admission favours TAVI.</jats:p> </jats:sec>