重度主动脉瓣狭窄行TAVR治疗方案临床效果的循证病案讨论

Evidence-Based case report on the effect of TAVR on the severe aortic stenosis

目的检索和评价当前的临床证据,比较经导管主动脉瓣置换术(TAVR)和外科主动脉瓣置换术(SAVR)的临床效果和安全性,为今后此类患者治疗方案的选择提供决策参考。方法计算机检索EMbase(1974~2016)、MEDLINE(1996~2016)和The Cochrane Library(2016年5期),搜集TAVR与SAVR比较治疗重度AS的Meta分析、随机对照试验(RCT)和病例-对照研究,对所获证据水平进行评价。基于临床证据和患者的情况,为患者制定治疗方案。结果获得相关研究21篇,其中Meta分析2篇。目前多数证据表明,与接受SAVR治疗的AS患者相比,接受TAVR治疗患者的病死率及心脑血管事件发生率并未升高;对合并较多基础疾病的患者,TAVR更加具优势。结论对多数重度AS患者,进行充分术前评估后,TAVR是行之有效的治疗手段之一。

Objective To search and review the best clinical evidence to compare the clinical therapeutic effects and safety between TAVR and SAVR, thereby guiding its clinical use and providing references of treatments for such patients. Methods EMbase （19742016）, MEDLINE （19962016） and The Cochrane Library （Issue 5, 2016） were systematically retrieved to collect randomized control trials, case-control studies and meta-analyses. Then, we assessed the quality of all the evidences to develop treatments based on those evidences and the situations of such patients. Results We identified 21 articles, including 2 articles of meta-analysis. With regard to the mortality and incidence of cardiovascular events, TAVR was not worse than SAVR. In addition, TAVR was more dominant than SAVR for patients who combined more basic diseases. Conclusion TAVR is one of the effective treatments for most patients with severe AS after sufficient assessment.