Transcatheter Valve Replacement in Patients with Aortic Valve Stenosis: An Overview of Systematic Reviews and Meta-Analysis with Different Populations.

IF 2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Arquivos Brasileiros de Cardiologia Pub Date : 2023-06-01 DOI:10.36660/abc.20220701

Henrique Diegoli, Marcia Regina Dias Alves, Lucas Miyake Okumura, Caroline Kroll, Dayane Silveira, Luiz Henrique Picolo Furlan

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引用次数: 1

Abstract

Background: Randomized controlled trials (RCTs) and observational studies have compared the efficacy and safety of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis.

Objectives: Compare TAVR and SAVR in patients with different surgical risks, population characteristics, and different transcatheter prosthetic valves.

Methods: An overview of systematic reviews (SRs) was conducted following a structured protocol. Results were grouped by surgical risk, population characteristics, and different valves. RCTs in the SRs were reanalyzed through meta-analyses, and the results were summarized using the GRADE method. The adopted level of statistical significance was 5%.

Results: Compared to SAVR, patients with high surgical risk using TAVR had a lower risk of (odds ratio, 95% confidence interval, absolute risk difference) atrial fibrillation (AF) (0.5, 0.29-0.86, -106/1000) and life-threatening bleeding (0.29, 0.2-0.42, -215/1000). Patients with intermediate surgical risk had a lower risk of AF (0.27, 0.23-0.33, -255/1000), life-threatening bleeding (0.15, 0.12-0.19, -330/1000), and acute renal failure (ARF) (0.4, 0.26-0.62, -21/1000). Patients with low surgical risk had a lower risk of death (0.58, 0.34-0.97, -16/1000), stroke (0.51, 0.28-0.94, -15/1000), AF (0.16, 0.12-0.2, -295/1000), life-threatening bleeding (0.17, 0.05-0.55, -76/1000), and ARF (0.27, 0.13-0.55, -21/1000), and had a higher risk of permanent pacemaker implantation (PPI) (4.22, 1.27-14.02, 141/1000). Newer generation devices had a lower risk of AF than older generations, and patients using balloon-expandable devices did not experience higher risks of PPI.

Conclusions: This paper provides evidence that patients at low, intermediate, and high surgical risks have better outcomes when treated with TAVR compared with SAVR.

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主动脉瓣狭窄患者的经导管瓣膜置换术:不同人群的系统评价和荟萃分析综述

背景:随机对照试验(RCTs)和观察性研究比较了经导管主动脉瓣置换术(TAVR)和手术主动脉瓣置换术(SAVR)治疗严重主动脉瓣狭窄患者的疗效和安全性。目的:比较不同手术风险、人群特点和不同经导管人工瓣膜患者的TAVR和SAVR。方法:对系统评价(SRs)进行概述，遵循结构化的方案。结果按手术风险、人群特征和不同瓣膜进行分组。通过荟萃分析对SRs中的随机对照试验进行重新分析，并使用GRADE方法对结果进行总结。采用统计学显著性水平为5%。结果:与SAVR相比，高手术风险患者使用TAVR发生心房颤动(AF)(0.5, 0.29-0.86， -106/1000)和危及生命的出血(0.29,0.2-0.42，-215/1000)的风险(优势比，95%置信区间，绝对风险差)较低。中等手术风险的患者发生AF(0.27, 0.23-0.33， -255/1000)、危及生命的出血(0.15,0.12-0.19，-330/1000)和急性肾功能衰竭(0.4,0.26-0.62，-21/1000)的风险较低。手术风险低的患者死亡(0.58,0.34-0.97，-16/1000)、卒中(0.51,0.28-0.94，-15/1000)、房颤(0.16,0.12-0.2，-295/1000)、危及生命的出血(0.17,0.05-0.55，-76/1000)、ARF(0.27, 0.13-0.55， -21/1000)风险较低，永久性起搏器植入(PPI)风险较高(4.22,1.27-14.02,141/1000)。新一代装置发生房颤的风险低于老一代，使用可膨胀气囊装置的患者发生PPI的风险也不高。结论:本文提供的证据表明，与SAVR相比，低、中、高手术风险的患者接受TAVR治疗的结果更好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Arquivos Brasileiros de Cardiologia 医学-心血管系统

CiteScore

3.70

自引率

30.80%

发文量

234

审稿时长

3-8 weeks

期刊介绍： With more than 70 years of existence, Arquivos Brasileiros de Cardiologia is the main channel for the dissemination of Brazilian scientific research on cardiovascular sciences. Published in two languages and indexed in major international databases, all scientific contributions are peer-reviewed and reviewed by editorial board members selected among the most reputable researchers in Brazil and abroad. The manuscripts are reviewed according to their relevance and originality, scientific accuracy and level of importance for the advancement of science. With an average time of nine months between the initial submission and the effective publication of the manuscripts, and less than seven months until they are published on PubMed, Arquivos Brasileiros de Cardiologia can ensure the quick inclusion of the researchers’ papers in the international literature.