Propitious temporal changes in clinical outcomes after transcatheter compared to surgical aortic valve replacement; a meta-analysis of over 65,000 patients.
Propitious temporal changes in clinical outcomes after transcatheter compared to surgical aortic valve replacement; a meta-analysis of over 65,000 patients.
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DOI：
10.1186/s13019-021-01689-3
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发表时间：
2021-10-20
影响因子：
1.6
通讯作者：
Biederman RWW
中科院分区：
文献类型：
--
作者：
Panchal A;Kyvernitakis A;Rayarao G;Doyle M;Biederman RWW
在过去十年中，经导管（TAVR）和外科主动脉瓣置换术（SAVR）中症状性重度主动脉瓣狭窄（AS）的治疗迅速发展，导致报告的临床结局改善。术者经验和技术改进改善了结局，尤其是接受TAVR的患者。我们试图使用当代荟萃分析来确定和比较1年结局。 我们使用关键词“AS”、“房颤”（AFib）和“卒中”检索了Medline（MESH）、科克伦和谷歌学者数据库。我们进行了一项荟萃分析，以比较TAVR与SAVR人群的术后卒中、1年全因和心血管死亡率。 共有23项研究符合分析标准，总人群为66，857例患者，其中61，913例接受TAVR，4944例接受SAVR。时间趋势表明，TAVR和SAVR组在十年内结局总体改善。TAVR组与SAVR组1年时卒中（3.1% vs. 5%）、全因（12.4% vs. 10.3%）和心血管死亡率（7.2% vs. 6.2%）方面的结局相似。尽管TAVR和SAVR结局在十年内总体上逐渐改善，但1年时全因、心血管死亡率和术后卒中的置信区间存在统计学重叠。虽然23项个体研究证明了每种技术在某些队列中的显著优势，但我们的分层手术分析整合了超过65，000例患者，表明TAVR在低风险和中等风险人群中与SAVR相当，而仅在最高风险人群中的短期和中期结局上级SAVR。这具有重大的社会经济影响，因为我们考虑将TAVR适应症扩展到低/中风险人群。
The treatment of symptomatic severe aortic stenosis (AS) has rapidly evolved over the past decade, in both transcatheter (TAVR) and surgical aortic valve replacement (SAVR), resulting in reported improved clinical outcomes. Operator experience and technical improvements have improved outcomes especially for patients undergoing TAVR. We sought to determine and compare 1-year outcomes using a contemporary meta-analysis. We searched the Medline (MESH), Cochrane and Google scholar databases using keywords “AS”, “atrial fibrillation” (AFib) and “stroke”. We performed a meta-analysis to compare TAVR with SAVR populations for post-procedural stroke, all-cause and cardiovascular mortality at 1-year. A total of 23 studies met criteria for analysis with total population of 66,857 patients, of which 61,913 had TAVR and 4944 had SAVR. Temporal trends demonstrated overall improvement in outcome for both, TAVR and SAVR groups through the decade. Outcomes, in terms of stroke (3.1% vs. 5%), all-cause (12.4% vs. 10.3%) and cardiovascular mortality (7.2% vs. 6.2%) were similar at 1-year, in TAVR versus SAVR, respectively. Despite overall gradual improvement in both TAVR and SAVR outcomes over the decade, there is a statistical overlap in confidence intervals for all-cause, cardiovascular mortality and postprocedural stroke at 1-year. While 23 individual studies demonstrate considerable advantages of each technique in certain cohorts, integrating over 65,000 pts with our stratified surgical analysis suggests that TAVR is comparable to SAVR for low and intermediate risk population while superior to SAVR only in the highest-risk population for short and intermediate term outcomes. This has substantial socio-economic implications as we contemplate expanding our TAVR indications to low/intermediate risk populations.
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影响因子：
24
作者：
Anderson, Jeffrey L.;Heidenreich, Paul A.;Shaw, Leslee J.
通讯作者：
Shaw, Leslee J.
影响因子：
37.8
作者：
Baron, Suzanne J.;Wang, Kaijun;Cohen, David J.
通讯作者：
Cohen, David J.
DOI：
10.1161/circinterventions.117.005417
发表时间：
2017-11-01
影响因子：
5.6
作者：
Abramowitz, Yigal;Vemulapalli, Sreekanth;Makkar, Raj R.
通讯作者：
Makkar, Raj R.
影响因子：
11.3
作者：
Chopard, Romain;Teiger, Emmanuel;Schiele, Francois
通讯作者：
Schiele, Francois
影响因子：
24
作者：
Chakravarty, Tarun;Patel, Akshar;Makkar, Raj R.
通讯作者：
Makkar, Raj R.