Mylavarapu Maneeth, Garcia Israel, Tanwar Niharika, Rao Nidhi Laxminarayan, Karnan Nithin, Jain Samiksha, Chilla Sri Lakshmi Sai Monica, Parrikh Kaksha, Kodali Lakshmi Sai Meghana, Kiyani Madiha
Department of Public Health, Adelphi University, NY, USA.
Department of Internal Medicine, St. George's University, West Indies, Grenada.
Ann Med Surg (Lond). 2025 Jul 23;87(9):5953-5962. doi: 10.1097/MS9.0000000000003599. eCollection 2025 Sep.
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.
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.
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; = 0.02), acute kidney injury [AKI] (OR 0.41; 0.33, 0.51; < 0.00001), AKI requiring dialysis (OR 0.66; 0.48, 0.91; = 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; < 0.0001), major vascular complications (OR 2.56; 1.09, 5.99; = 0.03).
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.
主动脉瓣狭窄（AS）的治疗方法包括经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）。然而，关于AS合并慢性肾脏病（CKD）患者术后临床结局的研究数据有限。本研究的目的是比较AS合并CKD患者TAVR和SAVR术后的临床结局。
根据PRISMA指南，在PubMed、EMBASE、Scopus和谷歌学术等多个数据库中进行了全面检索。纳入了比较基础CKD患者TAVR和SAVR临床结局的原始研究。
本研究纳入了23项研究，共69017例接受TAVR或SAVR的慢性肾脏病患者。接受TAVR的患者住院死亡率（OR 0.54；95%CI 0.32，0.91；P = 0.02）、急性肾损伤[AKI]（OR 0.41；95%CI 0.33，0.51；P < 0.00001）、需要透析的AKI（OR 0.66；95%CI 0.48，0.91；P = 0.01）及术后并发症（OR 0.34；95%CI 0.23，0.50；P<0.0001）的几率显著更低。然而，接受TAVR的患者永久起搏器植入[PPI]（OR 2.69；95%CI 1.96，3.69；P < 0.0001）、主要血管并发症（OR 2.56；95%CI 1.09，5.99；P = 0.03）的几率显著更高。
在AS合并CKD患者中，与SAVR相比，TAVR与显著更低的住院死亡率、急性肾损伤发生率降低及更少的术后并发症相关。然而，TAVR有更高的起搏器植入和主要血管并发症风险，凸显了个体化风险评估的重要性，并表明在适当选择的CKD患者中，TAVR是SAVR的有利替代方案。
