Meta-analysis of valve hemodynamics and left ventricular mass regression for stentless versus stented aortic valves
Meta-analysis of valve hemodynamics and left ventricular mass regression for stentless versus stented aortic valves
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DOI：
10.1016/j.athoracsur.2007.02.057
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发表时间：
2007-07-01
影响因子：
4.6
通讯作者：
Dunning, Joel
中科院分区：
文献类型：
--
作者：
Kunadian, Babu;Vijayalakshmi, Kunadian;Dunning, Joel
背景资料。无支架生物瓣膜是一种优于传统生物瓣膜的生物瓣膜，其优点包括左室上壁重量减少和有效瓣口面积增大。目前已有多项关于这一主题的高质量随机研究，我们试图通过荟萃分析对其进行总结。在MEDLINE、EMBASE、CRISP、MetaRegister of Control Trials和Cochrane数据库中检索了1995-2006年间的文献。还联系了专家，搜索了参考名单。研究采用逆方差固定效应模型进行组合。对异质性进行评估，并进行敏感性分析。同时对发表偏倚进行了调查。确定了10项研究，其中包括使用Freedom(Sorin Biomedica Cardio，Via Crescentino，意大利)、Freestyle(Medtronic，明尼阿波利斯，明尼苏达州)、Prima Plus(爱德华兹生命科学公司，加利福尼亚州欧文)以及多伦多和Biocor(圣裘德医疗，圣保罗，明尼苏达州)瓣膜的919名患者。无支架组的平均主动脉瓣梯度较低，加权平均差为-3.57 mm Hg(95%可信区间[CI]，-4.36~-2.78；p<；0.01)。无支架组术后6个月左心室重量指数显著降低(WMD，-6.42；95%CI，-11.63至-1.21；p=0.02)，12个月后这种改善消失(WMD，1.19；95%CI，-4.15至6.53；p=0.66)。使用无支架瓣膜的患者，平均增加了23分钟的交叉阻断时间，增加了29分钟的体外循环时间。这项荟萃分析显示，无支架主动脉瓣在6个月后改善了左心室质量的消退水平，降低了主动脉压差，改善了有效瓣口面积指数，但代价是阻断时间延长了23分钟，搭桥时间延长了29分钟。
Background. Stentless aortic bioprostheses have been advocated as being superior to conventional bioprosthetic valves, with benefits including superior left ventricular mass regression and larger effective orifice area. Several high-quality randomized studies now exist on this topic, and we sought to summarize them by meta-analysis.Methods. The literature was searched from 1995 to 2006, in MEDLINE, EMBASE, CRISP, metaRegister of Controlled Trials, and the Cochrane database. Experts were also contacted and reference lists searched. Studies were combined using the inverse variance fixed-effects model. Heterogeneity was assessed and a sensitivity analysis performed. Publication bias was also investigated.Results. Ten studies were identified that included 919 patients in which the Freedom (Sorin Biomedica Cardio, Via Crescentino, Italy), Freestyle (Medtronic, Minneapolis, MN), Prima Plus ( Edwards Life Sciences, Irvine, CA) and the Toronto and Biocor (St Jude Medical, St. Paul, MN) valves were used. The mean aortic valve gradient was lower in the stentless groups, with a weighted mean difference (WMD) of - 3.57 mm Hg (95% confidence interval [CI], - 4.36 to - 2.78; p < 0.01). The left ventricular mass index was significantly lower in the stentless groups at 6 months ( WMD, - 6.42; 95% CI, - 11.63 to - 1.21; p = 0.02), but this improvement disappeared after 12 months ( WMD, 1.19; 95% CI, - 4.15 to 6.53; p = 0.66). The weighted mean increase in cross-clamp time was 23 minutes, and the increase in bypass time was 29 minutes with a stentless valve.Conclusions. This meta-analysis showed that stentless aortic valves provide an improved level of left ventricular mass regression at 6 months, reduced aortic gradients, and an improved effective orifice area index, at the expense of a 23-minute longer cross-clamp time and a 29-minute longer bypass time.