摘要
<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We performed a systematic review and meta-analysis of all published studies with ≥5</span></span><span style="font-family:;" "=""></span><span style="font-family:;" "=""><span style="font-family:Verdana;">years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). </span><span style="font-family:Verdana;">Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The meta-</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male)</span><span style="font-family:Verdana;">. All TAVR procedures were performed with early</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">generations of THV. At</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33;95% CI: [1.78, 6.24], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 0%), all-cause mortality (OR 1.45;95% CI: [1.22, 1.75], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 44%) and the composite of reintervention and death (OR 1.47;95% CI: [1.14, 1.91], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 64%). Rates of myocardial infarction, transient ischemic attack, stroke, endocarditis, and the composite of endocarditis and thrombosis were similar between the groups. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: Despite comparable short and medium-term results, TAVR with early-generation THV has higher rates of reintervention and the composite of reintervention and death. Further studies employing newer definitions of structural valve deterioration and bioprosthetic valve failure are needed to assess whether technological enhancements in THV technology will improve long-term outcomes.</span></span>
<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We performed a systematic review and meta-analysis of all published studies with ≥5</span></span><span style="font-family:;" "=""></span><span style="font-family:;" "=""><span style="font-family:Verdana;">years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). </span><span style="font-family:Verdana;">Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The meta-</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male)</span><span style="font-family:Verdana;">. All TAVR procedures were performed with early</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">generations of THV. At</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33;95% CI: [1.78, 6.24], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 0%), all-cause mortality (OR 1.45;95% CI: [1.22, 1.75], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 44%) and the composite of reintervention and death (OR 1.47;95% CI: [1.14, 1.91], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 64%). Rates of myocardial infarction, transient ischemic attack, stroke, endocarditis, and the composite of endocarditis and thrombosis were similar between the groups. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: Despite comparable short and medium-term results, TAVR with early-generation THV has higher rates of reintervention and the composite of reintervention and death. Further studies employing newer definitions of structural valve deterioration and bioprosthetic valve failure are needed to assess whether technological enhancements in THV technology will improve long-term outcomes.</span></span>
作者
Kevin G. Buda
Michael S. Megaly
Vinayak N. Bapat
Robert Steffen
João L. Cavalcante
Santiago Garcia
Kevin G. Buda;Michael S. Megaly;Vinayak N. Bapat;Robert Steffen;João L. Cavalcante;Santiago Garcia(Division of Internal Medicine, Hennepin Healthcare, Minneapolis, USA;Division of Cardiology, Banner University Medical Center/University of Arizona, Phoenix, USA;Department of Cardiac Surgery, Abbott Northwestern Hospital, Minneapolis, USA;Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, USA)