Abstract WP422: Vascular Outcomes in TAVR v/s SAVR in End Stage Renal Disease Patients

Autor: Shravani Vindhyal, Sinan Khayyat, Mohinder Vindhyal, Zaher Fanari, Paul M Ndunda
Rok vydání: 2019
Předmět:
Zdroj: Stroke. 50
ISSN: 1524-4628
0039-2499
DOI: 10.1161/str.50.suppl_1.wp422
Popis: Background: End-stage renal disease patients undergoing dialysis have higher stroke risk causing significant comorbidity and mortality in patients undergoing cardiac surgery procedures. Transcatheter aortic valve replacement(TAVR) has been approved by the Food and Drug Administration's (FDA) as an alternative to surgical aortic valve replacement in patients with intermediate and high-risk comorbidities. Several observational studies have been published but very little data is available on outcomes with both of these procedures in patients on dialysis. Methods: We performed a meta-analysis of the observational studies which have transcatheter aortic valve replacement vascular outcomes in End-stage renal disease patients on dialysis from three different databases. Medline, Cochrane, and Web of Science were systematically searched for relevant studies and were screened by two independent investigators. Robins-I tool was used to analyze and assess the bias from the relevant studies. Results: Five studies were included in the analysis (Three of the studies were propensity-matched and the other two included cox proportional hazard model) including 619 TAVR and 697 SAVR patients. The overall risk of bias judgment for the propensity-matched studies was low and for the two cox proportional hazard models were low to moderate in bias due to confounding. TAVR patients on dialysis had similar major stroke 2.1% vs 3.8% [0.58 (CI: 0.29, 1.14); P value = 0.93, I2 = 0%], minor stroke rate of 2% vs 2% [1.0 (CI: 0.23, 4.43); P value = 0.37, I2 = 1%], major vascular complication rate of 4.2% vs 5.7% [0.73(CI: 0.38, 1.38); P value = 0.67, I2 = 0%], minor vascular complication rate of 8.4% vs 9.9% [0.83(CI: 0.51, 1.35); P value =0.49, I2 = 0%], major bleeding rate of 4.8% vs 6.5% [0.73(CI: 0.034, 1.60); P value = 0.58, I2 = 0%] and pacemaker insertion rate of11.9% vs 6.5% [1.93(CI: 1.28, 2.90); P value = 0.43, I2 = 0%]. Conclusions: Although the available data from observational studies show almost similar vascular outcomes in TAVR and SAVR in dialysis patients. There is definitely a trend showing lower major stroke rate, lower major and minor vascular complications but higher pacemaker implantation rate in TAVR group when compared to the SAVR.
Databáze: OpenAIRE
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