Transcatheter Aortic Valve Replacement for the Treatment of Pure Native Aortic Valve Regurgitation A Systematic Review
Transcatheter Aortic Valve Replacement for the Treatment of Pure Native Aortic Valve Regurgitation A Systematic Review
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DOI：
10.1016/j.jcin.2016.08.049
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发表时间：
2016-11-28
影响因子：
11.3
通讯作者：
Pilgrim, Thomas
中科院分区：
文献类型：
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作者：
Franzone, Anna;Piccolo, Raffaele;Pilgrim, Thomas
目的：本研究旨在总结经导管主动脉瓣置换术（TAVR）治疗先天性单纯主动脉反流（AR）的现有证据。手术主动脉瓣置换术（SAVR）是治疗AR的金标准。然而，有报道称，有高危患者接受TAVR治疗原生纯AR。方法：我们系统地检索Medline、Embase和Scopus，检索至少5例原生纯AR患者接受TAVR的报告。总结患者及手术特点。主要研究终点为全因死亡率。使用随机效应荟萃分析计算汇总估计值。该研究方案已在PROSPERO注册（CRD42016038422）。结果13篇报告237例患者纳入分析。79%的患者使用自膨胀假体，而21%的患者使用球囊可膨胀瓣膜。设备成功率在74%到100%之间。17例（7%）患者需要植入第二个瓣膜。6例（2.5%）转为SAVR。30天的全因死亡率为7%（95%置信区间[CI]: 3% ~ 13%； I-2 = 37%）。脑血管事件罕见（0%,95% CI: 0% ~ 1%; I-2 = 0）；大出血和血管并发症发生率分别为2% （95% CI: 0% ~ 7%; I-2 = 41%）和3% （95% CI: 1% ~ 7%; I-2 = 0%）。11%的患者需要植入永久性起搏器（95% CI: 5% - 19%; I-2 = 50%）。中度或重度术后AR发生率为9% （95% CI: 0% ~ 28%; I-2 = 90%）。结论：在被认为具有SAVR高风险的原生纯AR患者中，TAVR在技术上是可行的，并且与可接受的早期死亡风险相关。(C) 2016年由美国心脏病学会基金会发布。
OBJECTIVES This study sought to summarize available evidence on transcatheter aortic valve replacement (TAVR) for the treatment of native pure aortic regurgitation (AR).BACKGROUND Surgical aortic valve replacement (SAVR) is the gold standard for the treatment of AR. However, case series of high-risk patients undergoing TAVR for native pure AR were reported.METHODS We systematically searched Medline, Embase, and Scopus for reports of at least 5 patients with native pure AR undergoing TAVR. Patients' and procedural characteristics were summarized. The primary outcome of interest was all-cause mortality. Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO (CRD42016038422).RESULTS Thirteen reports including 237 patients were included in the analysis. Self-expandable prostheses were used in 79% of patients, whereas 21% of the patients were treated with a balloon-expandable valve. Device success ranged between 74% and 100%. Seventeen patients (7%) required the implantation of a second valve. Conversion to SAVR was reported in 6 (2.5%) cases. The rate of all-cause mortality at 30 days amounted to 7% (95% confidence interval [CI]: 3% to 13%; I-2 = 37%). Cerebrovascular events were rare (0%, 95% CI: 0% to 1%; I-2 = 0); major bleeding and vascular complications occurred in 2% (95% CI: 0% to 7%; I-2 = 41%), and 3% (95% CI: 1% to 7%; I-2 = 0%), respectively. Permanent pacemaker implantation was required in 11% of patients (95% CI: 5% to 19%; I-2 = 50%). The rate of moderate or severe post-procedural AR amounted to 9% (95% CI: 0% to 28%; I-2 = 90%).CONCLUSIONS Among selected patients with native pure AR deemed at high risk for SAVR, TAVR is technically feasible and associated with an acceptable risk of early mortality. (C) 2016 by the American College of Cardiology Foundation.