Trends in Cardiovascular Medicine最新文献

This systematic review and meta-analysis aim to provide a comprehensive analysis of the literature directly comparing the outcomes of surgical aortic valve replacement (SAVR) and TAVR in patients with BAV stenosis. Medline, PubMed, and Scopus were systematically searched for articles published between 2000 and 2023, 1862 studies were screened, and 6 retrospective studies met the inclusion criteria. We included 6550 patients in the final analyses: 3,292 and 3,258 in the SAVR and TAVR groups, respectively. Both groups have similar rates of in-hospital mortality (odds ratio (OR) 1.11; 95% CI 0.59–2.10; p = 0.75) and stroke (OR 1.25; 95% CI 0.85–1.86; p = 0.26. Patients who underwent SAVR experienced lower rates of permanent pacemaker implantation (OR 0.54; 95% CI 0.35–0.83; p = 0.005) and paravalvular leak (OR 0.47; 95% CI 0.26–0.86; p = 0.02). On the other hand, patients who underwent TAVR displayed lower rates of acute kidney injury (OR 1.81; 95% CI 1.15–2.84; p = 0.010), major bleeding (OR 3.76; 95% CI 2.18–6.49; p < 0.00001), and pulmonary complications (OR 7.68; 95% CI 1.21–48.84; p = 0.03). Despite the early mortality data suggesting that TAVR may be a reasonable strategy for patients with bicuspid AS with low to intermediate surgical risk, the increased risk of PPI and PVL is concerning. A prospective, randomized, controlled trial reporting long-term outcomes with pre-defined subgroup analyses based on BAV morphology is paramount. In the interim, caution should be exercised in the widespread adoption of TAVR in lower surgical-risk patients.

Background

Patients with advanced chronic kidney disease (CKD) are a challenging and understudied population. Specifically, the late outcomes following surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) in patients with CKD remains uncertain.

Objectives

To compare overall mortality risk in patients with moderate-to-severe CKD following TAVI versus SAVR.

Methods

Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by August 2022.

Results

Nine studies met our inclusion criteria. Patients who underwent TAVI had a higher 5-year mortality compared with patients undergoing SAVR in the overall population (HR 1.56, 95% CI 1.44–1.69, P < 0.001) and in populations with similar risk scores (HR 1.15, 95% CI 1.01–1.31, P = 0.035). The landmark analysis revealed a lower risk of 30-day mortality with TAVI (HR 0.62, 95% CI 0.41–0.94, P = 0.023), followed by similar risk until 7.5 months (HR 1, 95% CI 0.78–1.27, P = 0.978). In contrast, the landmark analysis beyond 7.5 months yielded a reversal of the HR in favor of SAVR (TAVI with HR 1.27, 95% CI 1.08–1.49 P = 0.003).

Conclusions

In patients with CKD, TAVI provides an initial survival benefit over SAVR. However, in the long run, a significant survival benefit of SAVR over TAVI was observed. Our findings highlight the need for randomized controlled trials to investigate outcomes in this special population.

Atherosclerotic plaque assessment has become a crucial element in the examination of cardiovascular diseases. Plaque may exhibit progression and could become unstable if not treated, making plaque regression and stabilization among the most important goals of any cardiovascular intervention in cardiovascular medicine. In this review, we explore the current understanding of plaque regression and stabilization, discuss imaging and measurement techniques, and examine the evidence for pharmacological interventions and other interventions aimed at addressing this condition.