Midterm outcome of transcatheter versus surgical aortic valve replacement in low to intermediate risk patients: A meta-analysis of randomized controlled trials.
Midterm outcome of transcatheter versus surgical aortic valve replacement in low to intermediate risk patients: A meta-analysis of randomized controlled trials.
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DOI：
10.1016/j.jjcc.2017.10.020
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发表时间：
2018-06
影响因子：
2.5
通讯作者：
Yanwei Wang;Yijiang Zhou;Li Zhang;Jianhua Zhu
中科院分区：
文献类型：
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作者：
Yanwei Wang;Yijiang Zhou;Li Zhang;Jianhua Zhu
背景目前的指南建议对不适合常规外科主动脉瓣置换术（SAVR）的严重症状性主动脉瓣狭窄（AS）患者进行经导管主动脉瓣置换术（TAVR）。鉴于最近在低风险患者中进行TAVR的趋势，我们评估了TAVR和SAVR治疗低至中等风险重度AS患者的中期结局。系统性检索了科克伦CENTRAL，以获得报告TAVR与SAVR在低至中等手术风险患者中的临床结局的随机对照试验，这些患者至少有2年的随访临床终点，包括死亡，急性肾损伤，心肌梗死，中风，永久性起搏器植入，危及生命的出血events.ResultsFrom 2000年至2017年，4个临床研究，包括4355例患者进行了评估。在2年随访时，TAVR的全因死亡（RR 0.86; 95%CI：0.67-1.10）、心血管死亡（RR 0.88; 95%CI：0.73-1.06）和卒中（RR 0.97; 95%CI：0.81-1.15）发生率相似。TAVR降低了出血事件（RR 0.45; 95%CI：0.28-0.73）和急性肾损伤（RR 0.48; 95%CI：0.25-0.93）的发生率。然而，TAVR与更高的永久性起搏器植入率相关（RR 3.01; 95%CI：1.04-8.72）。结论在低至中等手术风险的患者中，TAVR的中期临床结局在生存率和卒中率方面与SAVR相似，在减少危及生命的出血、急性肾损伤和新发房颤方面上级优于SAVR，但在增加永久性起搏器植入率方面劣于SAVR。
BackgroundCurrent guidelines recommend transcatheter aortic valve replacement (TAVR) in patients with severe symptomatic aortic stenosis (AS) who are not suitable for conventional surgical aortic valve replacement (SAVR). In light of the recent trend in performing TAVR in patients with lower risk profile, we assessed the midterm outcome comparing TAVR and SAVR for the treatment of patients with severe AS at low to intermediate risk.MethodsPubMed, EBSCO, and Cochrane CENTRAL were systematically searched for randomized controlled trials that reported the clinical outcomes of TAVR versus SAVR in patients at low to intermediate surgical risk with at least 2 years of follow-up. Clinical endpoints including death, acute kidney injury, myocardial infarction, stroke, permanent pacemaker implantation, and life-threatening bleeding events were assessed.ResultsFrom 2000 to 2017, 4 clinical studies comprising 4355 patients were identified. At 2-year follow-up, TAVR was associated with similar rate of death from any cause (RR 0.86; 95%CI: 0.67–1.10), cardiovascular death (RR 0.88; 95%CI: 0.73–1.06), and stroke (RR 0.97; 95%CI: 0.81–1.15). TAVR reduced incidence of bleeding events (RR 0.45; 95%CI: 0.28–0.73) and acute kidney injury (RR 0.48; 95%CI: 0.25–0.93). However, TAVR was associated with higher rate of permanent pacemaker implantation (RR 3.01; 95%CI: 1.04–8.72).ConclusionIn patients at low to intermediate surgical risk, midterm clinical outcomes of TAVR were similar to SAVR in survival and stroke rate, superior in reducing life-threatening bleeding, acute kidney injury, and new-onset atrial fibrillation, but inferior in increasing permanent pacemaker implantation.