经导管主动脉瓣置换术对于外科低危主动脉瓣狭窄患者有效性和安全性的Meta分析

Efficacy and safety of transcatheter aortic valve replacement in patients with severe aortic stenosis at low risk:a Meta-analysis

目的:比较经导管主动脉瓣置换术(TAVR)与外科主动脉瓣置换术(SAVR)对于外科低危的主动脉瓣狭窄患者的有效性及安全性。方法:通过计算机检索Pubmed、EMBASE和Cochrane数据库中比较TAVR和SAVR治疗外科低危主动脉狭窄患者的文章,包括随机对照试验(RCT)及非RCT。主要结局为短期(30 d)和长期(1年)的全因死亡率和卒中发生率。次要结局为短期(30 d)和长期(1年)的并发症。结果:共纳入10篇文献,其中RCT 5篇,队列研究5篇,共7 232例患者。汇总分析表明,TAVR较SAVR短期(30 d)全因死亡率和卒中发生率低,差异有统计学意义[全因死亡率:RR=0.67,95%CI:0.46~0.97,P=0.03;卒中发生率:RR=0.67,95%CI:0.46~0.96,P=0.03];TAVR与SAVR长期(1年)全因死亡率和卒中率无统计学差异[全因死亡率:RR=0.97,95%CI:0.76~1.23,P=0.77;卒中发生率:RR=0.73,95%CI:0.53~1.01,P=0.06];TAVR术后并发症(大出血、肾损伤、新发心房颤动)风险较SAVR低,而永久起搏器植入和血管并发症发生风险较SAVR高。结论:TAVR短期(30 d)死亡和卒中风险较SAVR低,在长期(1年)死亡和卒中风险方面两者无明显差异。TAVR较SAVR术后大出血、肾损伤、新发心房颤动风险更低,永久起搏器植入和血管并发症风险更高。

Objective:To compare the efficacy and safety of transcatheter aortic valve replacement(TAVR)and surgical aortic valve replacement(SAVR)in patients with aortic stenosis at low risk.Method:PubMed,EMBASE and Cochrane databases were searched for publications that related to TAVR and SAVR in patients with aortic stenosis at low risk,including randomized controlled trials(RCTs)and non-RCTs.The primary outcomes were short-term(30 days)and long-term(1 year)all-cause mortality and stroke.The secondary outcomes were short-term(30 days)and long-term(1 year)procedural complications.Result:Ten studies included 5 RCTs and 5 cohort studies with 7 232 patients were enrolled.Summary analysis showed that TAVR was associated with reduced risk for short-term(30 days)all-cause mortality and stroke[all-cause mortality:RR=0.67,95%CI:0.46-0.97,P=0.03;stroke:RR=0.67,95%CI:0.46-0.96,P=0.03].There was no significant difference in long-term(1 years)all-cause mortality and stroke between TAVR and SAVR[all-cause mortality RR=0.97,95%CI:0.76-1.23,P=0.77;RR=0.73,95%CI:0.53-1.01,P=0.06].In terms of postoperative complications,TAVR was associated with reduced risk for major bleeding,renal failure and new-onset atrial fibrillation and increased risk for vascular complications and permanent pacemaker implantation.Conclusion:The short-term(30 days)mortality and stroke risk of TAVR are lower than those of SAVR.There is no significant difference in long-term(1 year)mortality and stroke risk between TAVR and SAVR.TAVR has lower risk of major bleeding,renal injury and new atrial fibrillation,and higher risk of permanent pacemaker implantation and vascular complications than SAVR.