Abstract
Introduction
Aortic stenosis (AS) is treated with either transcatheter aortic valve replacement (TAVR) or Surgical aortic valve replacement (SAVR). However, limited data exist to study the postoperative clinical outcomes in patients with AS and chronic kidney disease (CKD). The objective of this study is to compare TAVR and SAVR postoperative clinical outcomes in patients with AS and CKD.
Methods
According to PRISMA guidelines, a comprehensive search was conducted across various databases such as PubMed, EMBASE, Scopus, and Google Scholar. Original studies that compared the clinical outcomes between TAVR and SAVR in patients with underlying CKD were included in the study.
Results
Twenty-three studies with 69 017 patients with chronic kidney disease who underwent TAVR or SAVR were included in this study. Patients who underwent TAVR had significantly lower odds of in-hospital mortality (OR 0.54; 0.32, 0.91; P = 0.02), acute kidney injury [AKI] (OR 0.41; 0.33, 0.51; P < 0.00001), AKI requiring dialysis (OR 0.66; 0.48, 0.91; P = 0.01), and postoperative complications (OR 0.34; 0.23, 0.50; p<0.0001). However, patients who underwent TAVR had significantly higher odds of permanent pacemaker implantation [PPI] (OR 2.69; 1.96, 3.69; P < 0.0001), major vascular complications (OR 2.56; 1.09, 5.99; P = 0.03).
Conclusion
In patients with AS and CKD, TAVR is associated with significantly lower in-hospital mortality, a reduced incidence of acute kidney injury, and fewer postoperative complications compared to SAVR. However, TAVR carries higher risks of pacemaker implantation and major vascular complications, highlighting the importance of individualized risk assessment and considering TAVR as a favorable alternative to SAVR in appropriately selected CKD patients.
Keywords: acute kidney injury, all-cause mortality, chronic kidney disease, meta-analysis, SAVR, TAVR
Introduction
Aortic stenosis (AS) is a progressive and debilitating valvular heart disease characterized by the narrowing of the aortic valve orifice. It poses a significant clinical challenge and is the most common valvular heart disease encountered in clinical practice[1-4]. Studies examining the incidence of severe AS have reported rates ranging from 52.5 to 53.8 per 100 000 patient-years[5]. Although the incidence of severe AS remained relatively stable over the past decade, the incidence of severe AS has increased in the aging population[5]. Calcific aortic sclerosis, precursor to AS, has also shown strong age dependency, with significant differences in prevalence between patients older than 65 years (29%) and those younger than 65 years (1%)[6]. Projections indicate that the incidence of AS will likely double in the coming decades due to the global aging trend, posing a significant public health challenge[6]. Patients with AS may experience a constellation of symptoms, including chest pain or tightness, dizziness or fainting, shortness of breath, fatigue, and palpitations. In advanced stages, AS can lead to severe complications such as congestive heart failure, sudden loss of consciousness, and sudden death[4-6]. Other potential complications include stroke, blood clots, bleeding, arrhythmias, and endocarditis[4,6]. Untreated symptomatic AS carries a poor prognosis, with an average survival of only 2-3 years after the onset of symptoms[7]. Furthermore, AS significantly reduces the quality of life of elderly patients, which in turn is associated with increased hospitalization and mortality[8]. Treatment, such as valve replacement, has improved prognosis, functional status, and quality of life[7].
AS was exclusively managed by surgical aortic valve replacement (SAVR), an open-heart procedure demanding substantial physiological reserve. However, the advent of transcatheter aortic valve replacement (TAVR) in 2002 revolutionized the therapeutic landscape[9,10]. TAVR, leveraging a minimally invasive catheter-based approach, has rapidly expanded its indications, now encompassing patients across the spectrum of surgical risk, including those previously deemed inoperable[11]. However, the decision between SAVR and TAVR remains nuanced, influenced by a complex interplay of patient-specific factors, including age, comorbidities, and anatomical considerations[12]. Compounding the complexity of AS management is the frequent co-occurrence of chronic kidney disease (CKD). CKD is a major risk factor for valvular heart disease, and aortic valve calcifications are highly prevalent in this patient group[13]. Functional evidence of AS has been found in 9.5% of CKD patients, compared to 3.5% in the general population[14]. Additionally, renal dysfunction, a well-established predictor of adverse cardiovascular outcomes, is alarmingly prevalent in patients with severe AS, often affecting over 75% of this population[12]. Notably, CKD has been identified as an independent risk factor for mid-term mortality following both SAVR and TAVR[12]. Despite this recognized association, a critical knowledge gap persists regarding the differential impact of CKD on prognosis post Aortic Valve Replacement (AVR).
According to existing research, valve choice in CKD should be made after considering life expectancy and risks of anticoagulation and reintervention, and the AVR decision is usually recommended by a heart-kidney team[15]. However, specific guidelines for AS in CKD are lacking in some areas[16]. Furthermore, the prognostic significance of CKD in severe AS is not fully understood[14], and evidence on AS progression in non-dialysis CKD is contradictory[17]. Despite the significant burden and gaps in the literature, advanced CKD patients are often excluded from AS treatment trials[15]. Furthermore, trials comparing TAVR to conservative management in CKD stages 3–5 with severe AS are lacking[18]. By rigorously synthesizing the available evidence, this meta-analysis aims to provide clinicians with comprehensive, robust, data-driven insights to inform personalized treatment strategies.
Methods
Per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines[19], a comprehensive literature search was conducted in several reliable databases, including PubMed/MEDLINE, Cochrane, EMBASE, Science Direct, and Google Scholar. Subject headings and keywords for “Transaortic catheter valve replacement,” “surgical aortic valve replacement,” “aortic valve surgery,” and ‘chronic kidney disease’ were used along with appropriate Boolean operators. The references of the selected studies were also examined to verify the comprehensiveness of the search. The search strategy utilized for the study is outlined in Supplementary Digital Content File S1, available at: http://links.lww.com/MS9/A892. Studies that compared the clinical outcomes of adult patients with AS and CKD who underwent Surgical aortic valve replacement or transaortic catheter valve replacement were included. A detailed list of inclusion and exclusion criteria was outlined in Supplementary Digital Content File S2, available at: http://links.lww.com/MS9/A892. Screening of the title and abstract was done independently by two reviewers, N.L.R. and N.T., and conflicts were resolved by a third reviewer, I.G. Full-text screening was done independently by two reviewers, N.K. and S.J, and conflicts were resolved by a third reviewer, M.M.. Figure 1 depicts the PRISMA flow chart outlining the study selection process[20]. The protocol of the study was registered in OSF (Open Science Framework) registry (Id: OSF.IO/4QD6R).
HIGHLIGHTS
TAVR is associated with significantly lower in-hospital mortality in CKD patients than SAVR.
TAVR results in lower rates of acute kidney injury (AKI) and dialysis-requiring AKI.
Postoperative complications are significantly reduced with TAVR versus SAVR.
TAVR is linked to higher rates of pacemaker implantation and major vascular complications.
The study underscores the need for tailored valve replacement strategies in CKD patients.
Figure 1.
PRISMA flowchart of study selection process. Abbreviation: CKD, Chronic Kidney Disease.
The risk of bias assessment was conducted using the adaptations of the New Castle Ottawa Scale (NOS)[21] and visualized using the Robvis software[22]. Outcomes are divided into postoperative outcomes, which include postoperative Intensive Care Unit (ICU) stay, postoperative complications (infections and bleeding), overall length of hospitalization (LOS), and other clinical outcomes, including in-hospital mortality, stroke, acute kidney injury (AKI), AKI requiring dialysis, major vascular complications, new-onset atrial fibrillation (AF), permanent pacemaker implantation (PPI), and Major Adverse Cardiac and Cerebrovascular Event (MACCE). Binary random effects were used to estimate the odds ratio (OR), and continuous random effects were used to estimate the mean differences (MD). Heterogeneity was assessed using the chi-squared (χ2) test and I2 statistics. The I2 statistic was interpreted as follows: 25% (low heterogeneity), 50% (moderate heterogeneity), and 75% (high heterogeneity). Funnel plots were utilized to evaluate for publication bias, where the degree of plot asymmetry was directly proportional to the degree of publication bias. All the statistical analyses were performed using the Review Manager (RevMan) version 5.4.1[23]. A P-value < 0.05 was considered to be statistically significant.
Results
Baseline characteristics
Our review includes 23 studies[24–46] (19 retrospective, 3 prospective, and 1 clinical trial) with 69,017 patients with AS and CKD. Of the 23, 14 were conducted in the United States, 6 in Europe, 2 in Asia, and 1 in Canada. Key characteristics of the included studies are enlisted in Table 1. Of the 69 017 patients, 32 581 underwent TAVR (54.2% males) and 36 436 under SAVR (61% males). Patients who underwent TAVR were significantly older (76.94 ± 9.57 years vs 70.30 ± 8.36 years) and had more comorbidities. Figure 2 depicts the comparison of comorbidities amongst the TAVR and SAVR groups.
Table 1.
Key characteristics of included studies.
| Study | Nationality | Study type | TAVR/SAVR, n |
|---|---|---|---|
| Bagur et al | Canada | Retrospective | 119/104 |
| Rau et al | Germany | Retrospective | 15/24 |
| Nguyen et al | United States | Retrospective | 162/421 |
| Kobin et al | United States | Retrospective | 194/194 |
| D’Errigo et al | Italy | Prospective | 170/170 |
| Alquhtani et al | United States | Retrospective | 197/197 |
| Bhise et al | United States | Retrospective | 119/244 |
| Condado et al | United States | Retrospective | 30/30 |
| Doshi et al | United States | Retrospective | 2485/2485 |
| Kumar et al | United States | Retrospective | 1001/1001 |
| Shavit et al | Israel | Prospective | 58/111 |
| Alkhalil et al | United States | Retrospective | 175/175 |
| Catalano et al | United States | Retrospective | 399/402 |
| Pineda et al | United States | RCT | 244/216 |
| Reuillard et al | France | Retrospective | 73/54 |
| Ando et al | United States | Retrospective | 5731/6491 |
| Färber et al | Germany | Retrospective | 661/457 |
| Khan et al | United States | Retrospective | 1065/654 |
| Lahoud et al | England | Retrospective | 319/319 |
| Mentias et al | United States | Retrospective | 4130/2565 |
| Sanaiha et al | United States | Retrospective | 2323/2993 |
| Kim et al | South Korea | Prospective | 77/70 |
| Peiero et al | Germany | Retrospective | 12834/17 059 |
RCT, randomized control trial
Figure 2.
Comparison of comorbidities between TAVR and SAVR groups. Abbreviation: PVD, Peripheral Vascular Disease; HF, Heart Failure; AF, Atrial Fibrillation; CAD, Coronary Artery Disease; MI, Myocardial Infarction; CLD, Chronic Liver Disease.
Postoperative outcomes
Patients who underwent TAVR had significantly lower odds of postoperative complications (OR 0.34; 95% CI 0.23, 0.50; P < 0.0001) compared to patients who underwent SAVR. Sub-grouping also showed that TAVR had significantly lower odds in postoperative infections (OR 0.23; 95% CI 0.13, 0.38; P < 0.0001) and postoperative bleeding (OR 0.47; 95% CI 0.30, 0.75; P = 0.002). Similarly, patients who underwent TAVR had a significantly lower overall LOS (WMD −6.37; 95% CI −7.68, − 5.07; P<0.00001) and lower postoperative ICU stay (WMD −1.96; 95% CI −4.25, 0.34; P = 0.09) (Fig. 3).
Figure 3.
Postoperative outcomes.
Abbreviation: LOS, length of stay
Other clinical outcomes
The TAVR group had significantly lower odds of in-hospital mortality (OR 0.54; 95% CI 0.32, 0.91; P = 0.02), AKI (OR 0.41; 95% CI 0.33, 0.51; P < 0.00001), and AKI requiring dialysis (OR 0.66; 95% CI 0.48, 0.91; P = 0.01) (Fig. 4). Although statistically insignificant, the TAVR group had lower odds of stroke (OR 0.75; 95% CI 0.51, 1.11; P = 0.15), new-onset AF (OR 0.40; 95% CI 0.14, 1.09; P = 0.07) (Supplementary Digital content File S3, available at: http://links.lww.com/MS9/A892).
Figure 4.
Clinical outcomes. Abbreviation: AKI, Acute Kidney Injury.
However, the TAVR group had significantly higher odds of major vascular complications (OR 2.56; 95% CI 1.09, 5.99; P = 0.03) and PPI (2.69; 95% CI 1.96, 3.69; P < 0.0001), and higher odds of MACCE (OR 1.15; 95% CI 0.58, 2.30; P = 0.69) (Supplementary Digital Content File S4, available at: http://links.lww.com/MS9/A892).
Assessment of heterogeneity and bias
Our analyses revealed significantly moderate to high heterogeneity in most outcomes assessed (Supplementary Digital content File S5, available at: http://links.lww.com/MS9/A892). The risk of bias across the included studies (22 studies) demonstrated a low risk across most domains (Fig. 5A). However, Rau et al. exhibited a high overall risk of bias primarily due to concerns with random sequence generation and allocation concealment, and multiple studies exhibited an “unclear” risk of bias (Fig. 5B). Publication bias was insignificant (Supplementary Digital Content File S6, available at: http://links.lww.com/MS9/A892).
Figure 5.
Risk of bias assessment. (A) Summary plot; (B) Traffic light plot.
Discussion
This meta-analysis, which includes 69 017 patients with AS and CKD, is the most comprehensive review to date. Patients with AS and CKD who underwent TAVR were older and more likely to have comorbidities such as hypertension, diabetes, chronic liver disease, and a history of myocardial infarction (MI). Despite this, TAVR demonstrated better clinical outcomes, including a lower risk of postoperative complications, shorter ICU stays, and reduced in-hospital mortality. These findings support existing guidelines suggesting TAVR as the preferred AVR procedure in older and high-risk patients[47–49].
TAVR is associated with lower in-hospital mortality compared to SAVR, supported by existing literature[50]. This could be explained by the minimally invasive nature of TAVR. Furthermore, studies have reported that the risk of mortality is higher in the SAVR group, especially in high-risk patients[51]. However, an early meta-analysis of these populations couldn’t find significant differences in mortality between the two groups[52]. The risk of postoperative AKI and AKI requiring dialysis was also lower in TAVR compared to the SAVR group, consistent with previous studies[50,52,53]. Studies have reported that postoperative AKI is a risk factor for in-hospital mortality[54], which could further explain the lower risk of mortality in our analysis.
Studies have established the reasons why the risk of postoperative AKI is relatively low in the TAVR group. Research has established that the need for cardiopulmonary bypass (CPB), CPB duration, hemodilution during CPB, and relatively low oxygen delivery due to CPB[55,56] increases the risk of AKI post-cardiac surgeries. The lack of need for CPB in TAVR explains the reduced risk. Hypotension secondary to bleeding increases the risk of AKI, due to reduced blood flow to the kidneys. Furthermore, blood transfusions increase the risk of AKI[57]. Significantly lower chances of postoperative bleeding in the TAVR group (P = 0.002) in our analysis further strengthen the above explanations.
Regarding postoperative stroke, prior studies have reported mixed findings. Wei et al. 2021[50] and Cheng et al. 2019[53] reported that postoperative stroke is significantly lower in the TAVR group, disproving a previous meta-analysis, Panchal et al 2018[52]. Athappan et al[58] report that improvement in valve technologies, patient selection criteria, and operator experience led to a significant decline in the risk of stroke post-TAVR in the general population, which explains the findings in Wei et al[50]. However, our analysis found that the lower risk of postoperative stroke post-TAVR was not significant. This could be due to Peiero et al 2021[46], which reported significantly higher odds of postoperative stroke (29 524 patients; OR 1.69; 95% CI 1.30, 2.20; P < 0.001) in the TAVR group.
Limitations
our comprehensive review provides insights into the comparative clinical outcomes of TAVR and SAVR in patients with AS and CKD. However, it isn’t devoid of limitations. First, our analyses exhibit considerable heterogeneity. This heterogeneity could be potentially due to variations in the patient characteristics, definitions of CKD, surgical techniques, and postoperative management. Second, almost all included studies (22/23) are observational, and most (19/22) are retrospective, which inherently carries the risk of confounding. Furthermore, one of the included studies had a high risk of bias due to random sequence generation and allocation concealment. Third, differences in valve delivery systems, surgeon training, and techniques in performing TAVR could also impact the outcomes. The geographic distribution of the included studies was uneven, with a significant concentration in the United States and Europe. Furthermore, the reliance on published studies may introduce publication bias, potentially skewing the observed outcomes. The variability in CKD staging across included studies and the lack of comprehensive patient-reported outcome data limit the scope of our findings. Additionally, the relatively short follow-up periods in many studies restrict our ability to fully evaluate the long-term efficacy and safety of TAVR and SAVR. Finally, the majority of studies are observational and concentrated in the US and Europe, which limits the generalizability of our study findings.
Clinical implications
Our study findings support TAVR as a viable alternative to SAVR, particularly in older patients with higher comorbidities. However, clinicians should be aware of the increased risk of major vascular complications and the need for permanent pacemaker implantation associated with TAVR. Careful patient selection and meticulous procedural techniques are essential to mitigate these risks. The differences in outcomes between the two groups underscore the importance of individualized patient assessment and tailored management strategies. Age, comorbidities, and anatomical considerations should be carefully weighed when deciding between the two procedures.
Future research
There exists a pressing need for large-scale, prospective, randomized controlled trials (RCTs) with the inclusion of CKD patients and standardized protocols and long-term follow-up to establish definitive conclusions regarding the comparative effectiveness and safety of TAVR versus SAVR in patients with AS and CKD. Current RCTs often either exclude CKD patients or do not stratify results based on renal function, limiting our ability to draw definitive conclusions for this high-risk population. Stratifying patients based on the CKD stage and defining clear, consistent criteria for each stage will allow for more precise and clinically relevant analyses. Research should also explore the long-term effects of TAVR and SAVR on CKD progression, including changes in estimated glomerular filtration rate (eGFR) and the incidence of end-stage renal disease. Furthermore, multicenter trials with diverse patient populations are needed to improve the generalizability of findings and ensure that results are applicable across different geographic regions and healthcare systems. Finally, future investigations, by incorporating patient-reported outcomes, such as quality of life and functional status, can provide a more comprehensive assessment of the impact of these interventions on patient well-being.
Conclusion
In conclusion, while TAVR offers advantages regarding short-term outcomes, careful patient selection and consideration of potential complications are crucial. Further research is warranted to refine treatment strategies and improve long-term outcomes in this challenging patient population.
Acknowledgements
Graphical abstract was made with Biorender.
The manuscript is reported in accordance to AMSTAR (Assessing the methodological quality of systematic reviews) checklist.
Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Maneeth Mylavarapu & Israel Garcia contributed equally to this work and share first authorship, i.e., co-first authors.
Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal's website, www.lww.com/international-journal-of-surgery
Contributor Information
Maneeth Mylavarapu, Email: dr.maneeth.mylavarapu@gmail.com.
Israel Garcia, Email: igarc097@gmail.com.
Niharika Tanwar, Email: niharikatanwar06@gmail.com.
Nidhi Laxminarayan Rao, Email: nidhi.22012000@gmail.com.
Nithin Karnan, Email: nithinkarnan@gmail.com.
Samiksha Jain, Email: samiksha190404@gmail.com.
Sri Lakshmi Sai Monica Chilla, Email: monicachilla428@gmail.com.
Kaksha Parrikh, Email: kakshaparrikh@gmail.com.
Lakshmi Sai Meghana Kodali, Email: klsmeghu@umich.edu.
Madiha Kiyani, Email: madihakiyani29@hotmail.com.
Ethical approval
No ethical approval was needed since this is a systematic review and meta-analysis.
Informed consent statement
Not applicable as this study did not involve humans or animals.
Sources of funding
None of the authors received funding for this manuscript.
Author contributions
M.M. and I.G. contributed to the conceptualization. M.M., N.T., N.L.R., N.K., S.J., S.L.S.M.C., K.P., I.G., and M.K. contributed to the design, execution, analysis, interpretation, and reporting. M.M., I.G., N.T., N.L.R., S.J., S.L.S.M.C., L.S.M.K., and K.P. contributed to the manuscript writing – original draft. M.M., I.G., L.S.M.K., and M.K. contributed to the manuscript writing – reviewing, and editing. M.M. contributed to the visualization. M.M. and I.G. supervised the work.
All the authors are accountable for all aspects of the work, reviewed the final draft, and consented to publication.
Conflicts of interest disclosure
All the authors declare no financial or any other conflicts of interest.
Guarantor
Maneeth Mylavarapu, serves as the guarantor for the work
Research registration unique identifying number (UIN)
The protocol of the study was registered in the OSF (Open Science Framework) registry (Id: OSF.IO/4QD6R)
Provenance and peer review
N/A
Data availability statement
Data extracted from the included studies used in the analysis is available with the corresponding author.
Institutional review board statement
Not applicable as this study did not involve humans or animals.
References
- [1].Sevilla T, Vilacosta I, San Román JA. Aortic stenosis. Estenosis aórtica. Med Clin (Barc) 2023;161:397–402. [DOI] [PubMed] [Google Scholar]
- [2].Hurrell H, Redwood M, Patterson T, et al. Aortic stenosis. BMJ 2023;380:e070511. [DOI] [PubMed] [Google Scholar]
- [3].Fukui M, Cavalcante JL, Bapat VN. Deformation in transcatheter heart valves: clinical implications and considerations. J Cardiol 2024;83:351–58. [DOI] [PubMed] [Google Scholar]
- [4].Nathaniel S, Saligram S, Innasimuthu AL. Aortic stenosis: an update. World J Cardiol 2010;2:135–39. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Benfari G, Essayagh B, Michelena HI, et al. Severe aortic stenosis: secular trends of incidence and outcomes [published correction appears in Eur Heart J. 2024 Jun 1;45(21):1900. doi: 10.1093/eurheartj/ehae144.]. Eur Heart J 2024;45:1877–86. [DOI] [PubMed] [Google Scholar]
- [6].Pujari SH, and Agasthi P. Aortic Stenosis. [Updated 2023 Apr 16]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. Accessed 26 March 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557628/ [PubMed] [Google Scholar]
- [7].Eveborn GW, Schirmer H, Heggelund G, et al. The evolving epidemiology of valvular aortic stenosis. the Tromsø study. Heart 2013;99:396–400. [DOI] [PubMed] [Google Scholar]
- [8].Frank D, Kennon S, Bonaros N, et al. Quality of life measures in aortic stenosis research: a narrative review. Cardiology 2023;148:556–70. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [9].Morrow RM, Kriza C, Urbán P, et al. Assessing the safety and efficacy of TAVR compared to SAVR in low-to-intermediate surgical risk patients with aortic valve stenosis: an overview of reviews. Int J Cardiol 2020;314:43–53. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [10].Kourkoveli P, Spargias K, Hahalis G. TAVR in 2017-What we know? What to expect? PubMed 2018;15:55–60. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [11].Aldalati O, Kaura A, Khan H, et al. Bioprosthetic structural valve deterioration: how do TAVR and SAVR prostheses compare? Int J Cardiol 2018;268:170–75. [DOI] [PubMed] [Google Scholar]
- [12].Rattanawong P, Kanitsoraphan C, Kewcharoen J, et al. Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta-analysis. Catheterization Cardiovasc Interventions 2019;94:E116–E127. [DOI] [PubMed] [Google Scholar]
- [13].Marwick TH, Amann K, Bangalore S, et al. Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019;96:836–49. [DOI] [PubMed] [Google Scholar]
- [14].Bohbot Y, Candellier A, Diouf M, et al. Severe aortic stenosis and chronic kidney disease: outcomes and impact of aortic valve replacement. J Am Heart Assoc 2020;9:e017190. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [15].Shroff GR, Bangalore S, Bhave NM, et al. Evaluation and management of aortic stenosis in chronic kidney disease: a scientific statement from the American heart association. Circulation 2021;143:e1088–e1114. [DOI] [PubMed] [Google Scholar]
- [16].Mallick S, Ogugua FM, Chedid M, et al. Evaluation and management of aortic stenosis in chronic kidney disease. J Heart Valve Soc 2024;1:30494826241296668. [Google Scholar]
- [17].Candellier A, Bohbot Y, Pasquet A, et al. Chronic kidney disease is a key risk factor for aortic stenosis progression. Nephrol Dial Transplant 2023;38:2776–85. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].Steinmetz T, Witberg G, Chagnac A, et al. Transcatheter aortic valve implantation versus conservative treatment in chronic kidney disease patients. EuroIntervention 2018;14:e503–e510. [DOI] [PubMed] [Google Scholar]
- [19].Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021. 372:n71. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [20].Haddaway NR, Page MJ, Pritchard CC, et al. PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev 2022;18:e1230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [21].Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010;25:603–05. [DOI] [PubMed] [Google Scholar]
- [22].McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 2021;12:55–61. [DOI] [PubMed] [Google Scholar]
- [23].Review Manager 5 (RevMan 5) [Computer program]. Version 5.4. Copenhagen: The Cochrane Collaboration, 2020. [Google Scholar]
- [24].Bagur R, Webb JG, Nietlispach F, et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 2010;31:865–74. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [25].Rau S, Wessely M, Lange P, et al. Transcatheter aortic valve implantation in dialysis patients. Nephron Clin Pract 2012;120:c86–c90. [DOI] [PubMed] [Google Scholar]
- [26].Nguyen TC, Babaliaros VC, Razavi SA, et al. Impact of varying degrees of renal dysfunction on transcatheter and surgical aortic valve replacement. J Thorac Cardiovasc Surg 2013;146:1399–13407. [DOI] [PubMed] [Google Scholar]
- [27].Kobrin DM, McCarthy FH, Herrmann HC, et al. Transcatheter and surgical aortic valve replacement in dialysis patients: a propensity-matched comparison. Ann Thorac Surg 2015;100:1230–37. [DOI] [PubMed] [Google Scholar]
- [28].D’Errigo P, Moretti C, D’Ascenzo F, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in patients with chronic kidney disease stages 3b to 5. Ann Thorac Surg 2016;102:540–47. [DOI] [PubMed] [Google Scholar]
- [29].Alqahtani F, Aljohani S, Boobes K, et al. Outcomes of transcatheter and surgical aortic valve replacement in patients on maintenance dialysis. Am J Med 2017;130:1464.e1–1464.e11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [30].Bhise V, Kanade P, Shantha GP, et al. Transcatheter and surgical aortic valve replacement in patients with end-stage renal disease. J Am Coll Cardiol 2017;69:1875–76. [DOI] [PubMed] [Google Scholar]
- [31].Condado JF, Maini A, Leshnower B, et al. End-stage renal disease and severe aortic stenosis: does valve replacement improve one-year outcomes? Catheter Cardiovasc Interv 2017;89:1109–15. [DOI] [PubMed] [Google Scholar]
- [32].Doshi R, Shah J, Patel V, et al. Transcatheter or surgical aortic valve replacement in patients with advanced kidney disease: a propensity score-matched analysis. Clin Cardiol 2017;40:1156–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [33].Kumar N, Khera R, Garg N, et al. Comparison of outcomes of transcatheter versus surgical aortic valve replacement in patients with chronic kidney disease. Am J Cardiol 2018;121:343–48. [DOI] [PubMed] [Google Scholar]
- [34].Shavit L, Silberman S, Tauber R, et al. Outcomes of transcatheter aortic valve implantation compared with surgical aortic valve replacement in geriatric patients with chronic kidney disease. Clin Nephrol 2018;90:87–93. [DOI] [PubMed] [Google Scholar]
- [35].Alkhalil A, Golbari S, Song D, et al. In-hospital outcomes of transcatheter versus surgical aortic valve replacement in end stage renal disease. Catheter Cardiovasc Interv 2018;92:757–65. [DOI] [PubMed] [Google Scholar]
- [36].Catalano M, Lin D, Cassiere H, et al. Incidence of acute kidney injury in patients with chronic renal insufficiency: transcatheter versus surgical aortic valve replacement. J Interv Cardiol 2019. 2019:9780415. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [37].Pineda AM, Kevin Harrison J, Kleiman NS, et al. Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement. Catheter Cardiovasc Interv 2019;93:740–48. [DOI] [PubMed] [Google Scholar]
- [38].Reuillard A, Garrouste C, Pereira B, et al. Evolution of chronic kidney disease after surgical aortic valve replacement or transcatheter aortic valve implantation. Arch Cardiovasc Dis 2019;112:162–70. [DOI] [PubMed] [Google Scholar]
- [39].Ando T, Briasoulis A, Takagi H, et al. Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis. J Card Surg 2020;35:3294–301. [DOI] [PubMed] [Google Scholar]
- [40].Färber G, Bleiziffer S, Doenst T, et al. Transcatheter or surgical aortic valve implantation in chronic dialysis patients: a German Aortic Valve Registry analysis. Clin Res Cardiol 2021;110:357–67. [DOI] [PubMed] [Google Scholar]
- [41].Khan MZ, Khan MU, Kalra A, et al. Transcatheter versus surgical aortic valve replacement in patients with end stage renal disease. Catheter Cardiovasc Interv 2020;96:1102–09. [DOI] [PubMed] [Google Scholar]
- [42].Lahoud R, Butzel DW, Parsee A, et al. Acute Kidney recovery in patients who underwent transcatheter versus surgical aortic valve replacement (from the Northern New England cardiovascular disease study group). Am J Cardiol 2020;125:788–94. [DOI] [PubMed] [Google Scholar]
- [43].Mentias A, Desai MY, Saad M, et al. Management of aortic stenosis in patients with end-stage renal disease on hemodialysis. Circ Cardiovasc Interv 2020;13:e009252. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [44].Sanaiha Y, Mantha A, Ziaeian B, et al. Trends in readmission and costs after transcatheter implantation versus surgical aortic valve replacement in patients with renal dysfunction. Am J Cardiol 2019;123:1481–88. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [45].Kim EC, Kim SH, Lee Y, et al. The impact of surgical versus transcatheter aortic valve replacement on postprocedural acute kidney injury in patients with chronic kidney disease. J Chest Surg 2022;55:435–41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [46].Mas-Peiro S, Faerber G, Bon D, et al. Impact of chronic kidney disease in 29 893 patients undergoing transcatheter or surgical aortic valve replacement from the German aortic valve registry. Eur J Cardiothorac Surg 2021;59:532–44. [DOI] [PubMed] [Google Scholar]
- [47].Srinivasan A, Wong F, Wang B. Transcatheter aortic valve replacement: past, present, and future. Clin Cardiol 2024;47:e24209. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [48].Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: executive Summary: a Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [published correction appears in Circulation. 2021 Feb 2;143(5):e228. doi: 10.1161/CIR.0000000000000960.] [published correction appears in Circulation. 2021 Mar 9;143(10):e784. doi: 10.1161/CIR.0000000000000966.]. Circulation 2021;143:e35–e71. [DOI] [PubMed] [Google Scholar]
- [49].Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease [published correction appears in Eur Heart J. 2022 Jun 1;43(21):2022. doi: 10.1093/eurheartj/ehac051.]. Eur Heart J 2022;43:561–632. [DOI] [PubMed] [Google Scholar]
- [50].Wei S, Zhang P, Zhai K, et al. Transcatheter versus surgical aortic valve replacement in aortic stenosis patients with advanced chronic kidney disease: a systematic review and meta-analysis. Ann Palliat Med 2021;10:7157–72. [DOI] [PubMed] [Google Scholar]
- [51].Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364:2187–98. [DOI] [PubMed] [Google Scholar]
- [52].Panchal HB, Leon MB, Kirtane AJ, et al. Transcatheter versus surgical aortic valve replacement in patients with moderate to severe chronic kidney disease: a systematic review and analysis. Struct Heart 2018;2:129–36. [Google Scholar]
- [53].Cheng X, Hu Q, Zhao H, et al. Transcatheter versus surgical aortic valve replacement in patients with chronic kidney disease: a meta-analysis. J Cardiothorac Vasc Anesth 2019;33:2221–30. [DOI] [PubMed] [Google Scholar]
- [54].Elhmidi Y, Bleiziffer S, Deutsch MA, et al. Acute kidney injury after transcatheter aortic valve implantation: incidence, predictors and impact on mortality. Arch Cardiovasc Dis 2014;107:133–39. [DOI] [PubMed] [Google Scholar]
- [55].Conlon PJ, Stafford-Smith M, White WD, et al. Acute renal failure following cardiac surgery. Nephrol Dial Transplant 1999;14:1158–62. [DOI] [PubMed] [Google Scholar]
- [56].Ranucci M, Pavesi M, Mazza E, et al. Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique. Perfusion 1994;9:319–26. [DOI] [PubMed] [Google Scholar]
- [57].Nuis RJ, Van Mieghem NM, Tzikas A, et al. Frequency, determinants, and prognostic effects of acute kidney injury and red blood cell transfusion in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2011;77:881–89. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data extracted from the included studies used in the analysis is available with the corresponding author.