Trans-Catheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Patients with Dialysis: Systematic Review and Meta-Analysis

Autor: Zaher Fanari, Paul M Ndunda, Sinan Khayyat, Mohinder Vindhyal, Venkata S Boppana
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Pacemaker
Artificial
Blood transfusion
medicine.medical_treatment
Comorbidity
030204 cardiovascular system & hematology
Risk Assessment
Transcatheter Aortic Valve Replacement
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Valve replacement
Aortic valve replacement
Renal Dialysis
Risk Factors
medicine
Humans
In patient
Blood Transfusion
030212 general & internal medicine
Hospital Mortality
Dialysis
Aged
Heart Valve Prosthesis Implantation
business.industry
Cardiac Pacing
Artificial
General Medicine
Aortic Valve Stenosis
Length of Stay
Middle Aged
medicine.disease
Surgery
Catheter
Treatment Outcome
Meta-analysis
Aortic Valve
Kidney Failure
Chronic
Female
Aortic valve calcification
Cardiology and Cardiovascular Medicine
business
Zdroj: Cardiovascular revascularization medicine : including molecular interventions. 20(10)
ISSN: 1878-0938
Popis: Dialysis is associated with higher rate of aortic valve calcification and higher cardiovascular mortality. Transcatheter aortic valve replacement (TAVR) is an established alternative for surgical aortic valve replacement (SAVR) in patients with higher and intermediate co-morbidities including dialysis.Two independent investigators systematically searched Medline, Cochrane, and Web of Science. The ROBINS-I tool was used to analyze and assess the bias from the selected studies.The search resulted in 4 observational studies with a total of 966 patients. TAVR in dialysis patients was associated with no significant difference in in-hospital mortality [8.1% vs 10.3%; OR (95% CI) 0.74 (0.35, 1.60), I2 = 50%, P = 0.45], risk-of-strokes at 30 days [2% vs 4.4%; OR (95% CI) 0.49 (0.22, 1.09), I2 = 0%, P = 0.08], vascular complications [12.7% vs 13.2%; OR (95% CI) 0.96 (0.55, 1.67), I2 = 0%, P = 0.89], need of blood transfusion [43.1% vs 66.4%; OR (95% CI) 0.27 (0.05, 1.39), I2 = 89%, P = 0.12], or bleeding risk [5.6% vs 6.8%; OR (95% CI) 0.91 (0.18, 4.64), I2 = 5%, P = 0.91] when compared to SAVR. TAVR was associated with significantly shorter length of stay [8.5 days vs 14.2 days; mean difference (95% CI) -5.89 (-9.13, -2.64), I2 = 76%, P 0.0001] and higher pacemaker implantation [11.4% vs 6.8%; OR (95% CI) 1.74 (1.07, 2.81), I2 = 5%, P = 0.02].TAVR outcomes were comparable to SAVR but had a significantly shorter length of stay and a higher pacemaker implantation rate in dialysis patients.
Databáze: OpenAIRE
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