接受经导管主动脉瓣置换术的主动脉瓣环较小患者使用球囊扩张瓣和自扩张瓣的血流动力学和临床结果:随机对照试验和倾向评分匹配研究的荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS IJC Heart and Vasculature Pub Date : 2024-10-28 DOI:10.1016/j.ijcha.2024.101542
Mushood Ahmed , Areeba Ahsan , Shehroze Tabassum , Irra Tariq , Eeshal Zulfiqar , Mahnoor Farooq Raja , Asma Mahmood , Raheel Ahmed , Farhan Shahid , Syed Khurram M. Gardezi , Mahboob Alam , Rodrigo Bagur , Mamas A. Mamas
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引用次数: 0

摘要

对于主动脉瓣环较小的患者,经导管主动脉瓣置换术(TAVR)被认为比手术主动脉瓣植入术更有效,但不同经导管心脏瓣膜(THV)的疗效比较仍不确定。为了确定符合条件的随机对照试验(RCT)和倾向分数匹配(PSM)研究,我们对从开始到2024年6月的所有数据库进行了文献检索。采用随机效应模型对临床结果进行评估,以得出风险比 (RR) 和 95% 置信区间 (CI)。分析包括 10 项研究,共 2,960 名患者。与 SEV 相比,BEV 的指数化有效孔面积明显更小(MD:-0.18,95 % CI:-0.27 至 -0.10),跨瓣平均压力梯度更高(MD:5.07,95 % CI 3.43 至 6.71)。接受 BEV 的患者发生假体与患者不匹配(PPM)(RR = 1.89,95 % CI:1.42 至 2.51)和严重 PPM(RR = 2.80,95 % CI:1.96 至 4.0)的风险明显高于接受 SEV 的患者。虽然在 30 天和 1 年全因死亡率、30 天卒中率、血管并发症、腔旁漏和永久起搏器植入方面,BEV 和 SEV 之间无显著差异(P > 0.05),但与接受 SEV 的患者相比,接受 BEV 的患者 1 年心血管死亡风险显著增加(RR = 1.61,95 % CI:1.05 至 2.47)。在 SAA 患者中,与 SEV 相比,BEV 的血液动力学性能更差,表现为中度和重度 PPM 风险更高。此外,使用 BEV 与较高的 1 年心血管死亡风险相关。
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Hemodynamic and clinical outcomes with balloon-expandable valves versus self-expanding valves in patients with small aortic annulus undergoing transcatheter aortic valve replacement: A meta-analysis of randomized controlled trials and propensity score matched studies
Transcatheter aortic valve replacement (TAVR) is considered more effective than surgical aortic valve implantation for patients with a small aortic annulus (SAA), however, the comparative efficacy of different transcatheter heart valves (THVs) remains uncertain. A literature search was performed across databases from their inception until June 2024 to identify eligible randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95 % confidence intervals (CIs). The analysis included 10 studies with 2,960 patients. BEVs were associated with a significantly smaller indexed effective orifice area (MD: −0.18, 95 % CI: −0.27 to −0.10), and a higher transvalvular mean pressure gradient (MD: 5.07, 95 % CI 3.43 to 6.71) than SEVs. The risk for prosthesis-patient mismatch (PPM) (RR = 1.89, 95 % CI: 1.42 to 2.51) and severe PPM (RR = 2.80, 95 % CI: 1.96 to 4.0) was significantly higher for patients receiving BEVs than those receiving SEVs. Although nonsignificant differences were observed between BEVs and SEVs regarding 30-day and 1-year all-cause mortality, 30-day stroke rates, vascular complication, paravalvular leak, and permanent pacemaker implantation (p > 0.05), patients receiving BEVs were associated with a significantly increased risk of 1-year cardiovascular mortality (RR = 1.61, 95 % CI: 1.05 to 2.47) compared to those receiving SEVs. In patients with SAA, BEVs demonstrated worse hemodynamic performance as determined by the higher risk of moderate and severe PPM compared to SEVs. Moreover, the use of BEVs was associated with a higher risk of 1-year cardiovascular mortality.
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来源期刊
IJC Heart and Vasculature
IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
10.30%
发文量
216
审稿时长
56 days
期刊介绍: IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.
期刊最新文献
Ten-year outcomes after transcatheter or surgical aortic valve replacement in low-risk patients: The OBSERVANT study Postoperative delirium in patients undergoing TAVI versus SAVR – A systematic review and meta-analysis Age-dependent hypertrophy and fibrosis dynamics in hypertrophic cardiomyopathy: Insights from longitudinal CMR studies Role of Lipoprotein (A) in aortic valve stenosis: Novel disease mechanisms and emerging pharmacotherapeutic approaches Hemodynamic and clinical outcomes with balloon-expandable valves versus self-expanding valves in patients with small aortic annulus undergoing transcatheter aortic valve replacement: A meta-analysis of randomized controlled trials and propensity score matched studies
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