经导管主动脉瓣置换术对高龄主动脉瓣狭窄患者临床疗效的系统评价与Meta分析

Clinical efficacy of transcatheter aortic valve replacement in elderly patients with aortic stenosis:A systematic review and meta-analysis

目的比较≥90岁与<90岁主动脉瓣狭窄(aortic valve stenosis,AS)患者行经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)后的并发症,探讨临床上高龄(≥90岁)AS患者行TAVR的有效性和安全性。方法计算机检索PubMed、The Cochrane Library、EMbase、Medline、中国知网(CNKI)、万方和中国生物医学文献数据库(CBMdisc)中关于≥90岁与<90岁AS患者行TAVR的文献。检索时限为建库至2019年5月。由2位评审员独立筛选文献、提取资料和评价文献质量。采用RevMan 5.3和Stata 15.0软件进行Meta分析。结果共纳入12篇队列研究,包括60186例患者,其中≥90岁有11350例,<90岁有48836例。Meta分析结果显示:≥90岁患者术后院内全因死亡率[OR=1.51,95%CI(1.37,1.66),P<0.00001]、30 d全因死亡率[OR=1.68,95%CI(1.50,1.89),P<0.00001]及1年全因死亡率[OR=1.36,95%CI(1.25,1.48),P<0.00001]均高于<90岁患者。≥90岁患者卒中[OR=1.31,95%CI(1.18,1.46),P<0.00001]、出血事件[OR=1.14,95%CI(1.07,1.20),P<0.00001]及血管并发症[OR=1.31,95%CI(1.18,1.46),P<0.00001]发生率高于<90岁患者。结论≥90岁AS患者行TAVR后的全因死亡率和一些并发症发生率均高于<90岁患者,但这种差异在临床上是可以接受的。因此高龄患者行TAVR治疗是安全且有效的。

Objective To compare the complications of transcatheter aortic valve replacement(TAVR)between aortic valve stenosis(AS)patients≥90 years and patients<90 years,and to explore the efficacy and safety of TAVR in AS patients≥90 years.Methods Databases including PubMed,The Cochrane Library,EMbase,Medline,CNKI,Wanfang Data and China Biology Medicine disc(CBMdisc)were searched by computer from inception to May 2019.Two reviewers independently screened the literature,extracted the data and evaluated the quality of the included studies.RevMan 5.3 and Stata 15.0 were used for meta-analysis.Results A total of 12 cohort studies were included,including 60186 patients(11350 patients≥90 years and 48836 patients<90 years).Meta-analysis showed that compared with the patients<90 years,those≥90 years had higher all-cause mortality in the hospital(OR=1.51,95%CI 1.37 to 1.66,P<0.00001),on postoperative 30 d(OR=1.68,95%CI 1.50 to 1.89,P<0.00001)and at postoperative 1 year(OR=1.36,95%CI 1.25 to 1.48,P<0.00001),and had higher incidence of stroke(OR=1.31,95%CI 1.18 to 1.46,P<0.00001),bleeding events(OR=1.14,95%CI 1.07 to 1.20,P<0.00001)and vascular complications(OR=1.31,95%CI 1.18 to 1.46,P<0.00001).Conclusion All-cause mortality and the incidence of some complications after TAVR in AS patients≥90 years are higher than those in patients<90 years,but this difference is clinically acceptable.Therefore,TAVR treatment is safe and effective for elderly patients.