Comparative Efficacy and Safety of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Patients With End-Stage Renal Disease: A Systematic Review and Meta-Analysis.

End-stage renal disease (ESRD) severely elevates the risks of aortic stenosis interventions. While surgical aortic valve replacement (SAVR) has traditionally been the gold standard treatment, transcatheter aortic valve replacement (TAVR) has been introduced as a minimally invasive alternative. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of TAVR compared with SAVR in patients with ESRD. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search of databases PubMed, Embase, and Web of Science up to March 2025 found 7 cohort studies comprising 15,462 patients. Primary outcomes consisted of 30-day and in-hospital mortality, while secondary outcomes evaluated pacemaker implantation, complications, length of stay, costs, and discharge report. TAVR was related to considerably lower in-hospital mortality (risk ratio, 0.52) and a pattern toward decreased 30-day mortality. It also decreased the risks of cardiac tamponade, respiratory issues, blood transfusions, and transfers to other facilities. No TAVR was associated with increased rates of pacemaker implantation and vascular complications. It notably shortened hospital stay and enhanced home discharge rates, while healthcare costs were lower compared with SAVR. Sensitivity analyses validated the reliability of most findings. Regardless of high heterogeneity and limitations consisting of geographic restriction to the United States and limited long-term outcomes, this study contributes to evidence that TAVR may offer superior short-term outcomes for patients with ESRD, especially those at high surgical risk. Clinical decisions should be personalized, weighing procedural risks against impactful benefits.