Background: Transcatheter aortic valve implantation (TAVI) has become the main treatment for symptomatic severe aortic stenosis but patients on dialysis have been excluded from major randomized controlled trials. Our aim was to compare outcomes after TAVI of patients with end-stage renal disease (ESRD) on dialysis versus those without.
Methods: EMBASE and MEDLINE were searched through June 2019 to investigate the comparative outcomes between ESRD patients on dialysis and those without who underwent TAVI. The main outcomes were short-term (30-day/in-hospital) mortality and procedural complications, and long-term (> 6 months) all-cause mortality.
Results: Our search identified 10 observational studies enrolling a total of 128,094 (5,399 on dialysis) patients. Patients with dialysis had a significantly higher rate of short-term and long-term mortality compared to those without (odds ratio [95% confidential interval]: 2.18 [1.64-2.89], P < 0.001, I2=60%; 1.91 [1.46-2.50], P < 0.001, I2=80%, respectively) (Figures 1, 2). In addition, patients on dialysis had significantly higher rates of short-term life threatening and/or major bleeding, permanent pacemaker implantation, and device failure (OR [95% CI]: 1.90 [1.24-2.90], P < 0.001, I2=67%; 1.33 [1.15-1.53], P < 0.001, I2=0%; 2.08 [1.05-4.10], P = 0.03, respectively), but did not have significantly higher rates of vascular complications and stroke.
Conclusions: Dialysis patients had significantly higher rates of short- and long-term mortality, short-term life threatening and/or major bleeding, permanent pacemaker implantation, and device failure. Careful patient selection who would benefit from TAVI among those with ESRD requiring dialysis, or who would need deferral of TAVI, is necessary to prevent high-rates of post-procedural adverse outcomes.
