Short- and Long-term Outcomes in Dialysis Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

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 mortality and procedure-related complications after TAVI in patients with end-stage renal disease (ESRD) on dialysis vs those without. Methods: EMBASE and MEDLINE were searched through November 2019 to investigate the comparative outcomes between patients with ESRD 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 128,094 (5399 on dialysis) patients who underwent TAVI. Dialysis patients had a significantly higher rate of short-term and long-term mortality than nondialysis patients (odds ratio [95% confidential interval]: 2.18 [1.64-2.89], P < 0.001, I-2 = 60%; 1.91 [1.46-2.50], P < 0.001, I-2 = 80%, respectively). In addition, dialysis patients had significantly higher rates of short-term life-threatening and/or major bleeding, permanent pacemaker implantation, and device failure compared with nondialysis patients (odds ratio [95% confidential interval]: 1.90 [1.24-2.90], P < 0.001, I-2 = 67%; 1.33 [1.15-1.53], P < 0.001, I-2 = 0%; 2.08 [1.05-4.10], P = 0.03, respectively), but did not have significantly higher rates of vascular complications and stroke. Conclusion: 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 compared with nondialysis patients. Careful selection of patients who would benefit from TAVI among patients with ESRD requiring dialysis is necessary to prevent high rates of postprocedural complications.