Moderate and Severe Preoperative Chronic Kidney Disease Worsen Clinical Outcomes After Transcatheter Aortic Valve Implantation

Abstract

Background— There is a conflicting evidence on safety and efficacy of transcatheter aortic valve implantation in patients with preoperative chronic kidney disease (CKD). Therefore, we conducted a meta-analysis on the impact of CKD on outcomes after transcatheter aortic valve implantation. Methods and Results— Nine studies including 4992 patients were analyzed. Overall preoperative CKD (stages 3–5) significantly increased early (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.08–1.94 and OR, 1.66; 95% CI, 1.04–2.67) and 1-year (OR, 1.66; 95% CI, 1.23–2.25 and OR, 1.32; 95% CI, 1.06–1.63) all-cause and cardiovascular mortality, respectively. Moderate CKD (stage 3) alone also increased early and 1-year all-cause mortality (OR, 1.43; 95% CI, 1.10–1.85 and OR, 1.41; 95% CI, 1.13–1.74). CKD stages 4 to 5 and 3 compared with stages 1 to 2 increased early stroke (OR, 2.67; 95% CI, 1.53–4.65 and OR, 1.66; 95% CI, 1.09–2.52), acute kidney injury (OR, 2.09; 95% CI, 1.17–3.72 and OR, 1.32; 95% CI, 1.09–1.60) and need for dialysis (OR, 5.92; 95% CI, 2.46–14.27 and OR, 1.55; 95% CI, 0.65–3.70), in the absence of significant differences in contrast medium administration (mean difference, −26.07; 95% CI, −53.00 to 0.85 and mean difference, −0.42; 95% CI, −16.10 to 15.26). Bleeding (life-threatening or major) was nonsignificantly increased in CKD 3 to 5 compared with CKD 1 to 2, but significantly increased in most severe patients (CKD 4–5 versus CKD 1–2: OR, 1.66; 95% CI, 1.13–2.44; CKD 4–5 versus CKD 3: OR, 1.68; 95% CI, 1.27–2.24). Conclusions— Both moderate and severe preoperative CKD significantly worsen transcatheter aortic valve implantation prognosis. Future studies on risk evaluation, prevention, and postoperative management are needed.