Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
复制标题
经导管主动脉瓣置换术后死亡原因：系统回顾和荟萃分析
DOI：
10.1161/jaha.115.002096
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发表时间：
2015-09-21
影响因子：
5.4
通讯作者：
Chen M
中科院分区：
文献类型：
--
作者：
Xiong TY;Liao YB;Zhao ZG;Xu YN;Wei X;Zuo ZL;Li YJ;Cao JY;Tang H;Jilaihawi H;Feng Y;Chen M
背景经导管主动脉瓣置换术（TAVR）是手术风险高的患者主动脉瓣置换术的有效替代方法。然而，很少有关于确切死亡原因的出版文献。方法和结果系统地检索PubMed数据库中报告TAVR术后30天内和30天后死亡原因的研究。在3934个检索结果中确定了28个研究。在整体分析中，46.4%和51.6%的死亡分别与前30天内和之后的非心血管原因有关。TAVR后30天内，感染/败血症（18.5%）、心力衰竭（14.7%）和多器官衰竭（13.2%）是前3位死亡原因。超过30天，感染/败血症（14.3%）、心力衰竭（14.1%）和猝死（10.8%）是最常见的原因。进行了所有可能的亚组分析。tavr后30天，除了中度（平均STS评分4 ~ 8分）和高度（平均STS评分80分）风险患者之间的比较（56.0% vs 33.5%， P=0.005）外，心血管死亡比例无显著差异。结论在TAVR术后围手术期和长期随访中，心血管和非心血管死亡原因基本平衡。感染/败血症和心力衰竭是最常见的非心血管和心血管死亡原因。这项研究强调了临床重点的重要领域，可以进一步改善TAVR后的预后。
Background Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement in patients at high surgical risk. However, there is little published literature on the exact causes of death. Methods and Results The PubMed database was systematically searched for studies reporting causes of death within and after 30 days following TAVR. Twenty-eight studies out of 3934 results retrieved were identified. In the overall analysis, 46.4% and 51.6% of deaths were related to noncardiovascular causes within and after the first 30 days, respectively. Within 30 days of TAVR, infection/sepsis (18.5%), heart failure (14.7%), and multiorgan failure (13.2%) were the top 3 causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure (14.1%), and sudden death (10.8%) were the most common causes. All possible subgroup analyses were made. No significant differences were seen for proportions of cardiovascular deaths except the comparison between moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005). Conclusions Cardiovascular and noncardiovascular causes of death are evenly balanced both in the perioperative period and at long-term follow-up after TAVR. Infection/sepsis and heart failure were the most frequent noncardiovascular and cardiovascular causes of death. This study highlights important areas of clinical focus that could further improve outcomes after TAVR.