50~70岁主动脉瓣病变患者行生物瓣膜与机械瓣膜置换术后的远期临床结局的meta分析

Long term clinical outcomes after biological valve replacement and mechanical valve replacement in patients with aortic valve lesion aged 50-70 years old: a meta-analysis

目的 评价50~70岁主动脉瓣病变患者接受生物瓣膜(BV)与机械瓣膜(MV)置换术后的远期临床结局。方法 从Medline、Embase、Web of Science、The Cochrane Library、PubMed、中国知网、万方和SinoMed 8个数据库中检索与主动脉瓣置换术(AVR)相关的文献,将符合标准的文献纳入研究,提取研究特征和相关数据,采用纽斯卡尔-渥太华文献质量评价量表(NOS)对纳入文献的质量进行评分,RevMan 5.0软件进行meta分析。结果 共纳入10篇文献,共7 565例患者,其中BV组3 658例,MV组3 907例,NOS评分6~7分。meta分析结果显示:BV组出血事件发生率低于MV组[RR=0.60,95%CI(0.51,0.69),P<0.01],瓣膜结构性衰败发生率高于MV组[RR=6.87,95%CI(2.17,21.75),P<0.01],再次手术发生率高于MV组[RR=2.63,95%CI(2.12,3.28),P<0.01],人工瓣膜感染性心内膜炎发生率高于MV组[RR=2.06,95%CI(1.40,3.04),P<0.01]。结论 50~70岁主动脉瓣病变存在出血性疾病和出血风险高的患者选择BV较为合适,而在瓣膜结构性衰败、再次手术、人工瓣膜感染性心内膜炎发生率方面,MV显示出一定的优越性。

Objective To evaluate the long term clinical outcome of the patients with aortic valve lesion aged 50-70 years old receiving aortic valve replacements(AVR) of conventional biovalve(BV) and mechanical valve(MV).Methods The AVR related papers were retrieved from the eight databases of Medline, Embase, Web of Science, the Cochrane Library, PubMed, CNKI,Wanfang and SinoMed.The literatures meeting the criteria were included in the study.The study characteristics and related data were extracted.The quality of included literatures was evaluated by the Newcastle-Ottawa scale(NOS).The RevMan 5.0 software was used for conducting the meta analysis.Results A total of 10 papers were included and involved 7 565 patients, 3 658 cases in the BV group and 3 907 in the MV group, and the NOS scores were 6-7 points.The meta analysis results showed that the incidence rate of bleeding events in the BV group was lower than that in the MV group [RR=0.60,95%CI(0.51,0.69),P<0.01].The incidence rate of structural valve deterioration in the BV group was higher than that in the MV group [RR=6.87,95%CI(2.17,21.75),P<0.01].The incidence rate of reoperation in the BV group was higher than that in the MV group [RR=2.63,95%CI(2.12,3.28),P<0.01].The incidence rate of artificial vale endocarditis in the BV group was higher than that in the MV group [RR=2.06,95%CI(1.40,3.04),P<0.01].Conclusion Selecting BV is suitable for the patients with aortic valve lesion, aged 50-70 years old and existing high bleeding risk and hemorrhagic disease.In terms of valve structural decay, reoperation and incidence rate of infective endocarditis of artificial valve, MV shows certain superiority.