Outcomes following TAVR in patients with cardiogenic shock: A systematic review and meta-analysis.

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ahmad Jabri, Mohammed Ayyad, Maram Albandak, Ahmad Al-Abdouh, Luai Madanat, Basma Badrawy Khalefa, Laith Alhuneafat, Asem Ayyad, Alejandro Lemor, Mohammed Mhanna, Zaid Al Jebaje, Raef Fadel, Pedro Engel Gonzalez, Brian O'Neill, Rodrigo Bagur, Ivan D Hanson, Amr E Abbas, Tiberio Frisoli, James Lee, Dee Dee Wang, Vikas Aggarwal, Khaldoon Alaswad, William W O'Neill, Herbert D Aronow, Mohammad AlQarqaz, Pedro Villablanca
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引用次数: 0

Abstract

Background: While transcatheter aortic valve replacement (TAVR) has broadened treatment options for critically ill patients, outcomes among those with concomitant cardiogenic shock (CS) are not well-explored.

Methods: We conducted a comprehensive search of major databases for studies comparing outcomes following TAVR in patients with and without CS since inception up to October 31, 2023. Our meta-analysis included five non-randomized observational. Dichotomous outcomes were assessed using the Mantel-Haenszel method (risk ratio, 95 % CI), and continuous outcomes were evaluated using mean difference and 95 % CI with the inverse variance method. Statistical heterogeneity was determined using the inconsistency test (I2).

Results: Among 26,283 patients across five studies, 30-day mortality was higher in the CS group (7267 patients; 27.6 %) compared to those without CS (OR 3.41, 95 % CI [2.01, 5.76], p < 0.01), as well as 30-day major vascular complications (OR 1.72, 95 % CI [1.54, 1.92], p < 0.01). At 1-year follow-up, there was no statistically significant difference in mortality rates between the compared groups (OR 2.68, 95 % CI [0.53, 13.46], p = 0.12). No significant between-group differences were observed in the likelihood of 30-day aortic valve reintervention (OR 3.20, 95 % CI [0.63, 16.22], p = 0.09) or post-TAVR aortic insufficiency (OR 0.91, 95 % CI [0.33, 2.51], p = 0.73). Furthermore, 30-day stroke, pacemaker implantation, and in-hospital major bleeding were comparable between both cohorts.

Conclusion: Among patients undergoing TAVR, short-term mortality is higher but one-year outcomes are similar when comparing those with, to those without, CS. Future studies should examine whether TAVR outcomes are improved when the procedure is delayed to optimize CS and when delay is not possible, whether particular management strategies lead to more favorable periprocedural outcomes.

心源性休克患者进行 TAVR 后的疗效:系统回顾和荟萃分析。
背景:虽然经导管主动脉瓣置换术(TAVR)拓宽了重症患者的治疗选择,但对伴有心源性休克(CS)的患者的治疗效果还没有进行深入研究:我们对主要数据库进行了全面检索,比较了自 TAVR 开始至 2023 年 10 月 31 日期间有无 CS 患者的治疗效果。我们的荟萃分析包括五项非随机观察性研究。采用曼特尔-海恩泽尔法(风险比、95% CI)评估二分法结果,采用反方差法评估均值差异和95% CI,评估连续性结果。统计异质性采用不一致性检验(I2)确定:在五项研究的26283名患者中,CS组(7267名患者;27.6%)的30天死亡率高于无CS组(OR 3.41,95% CI [2.01,5.76],P 结论:在接受TAVR的患者中,CS组的短期死亡率高于无CS组:在接受 TAVR 的患者中,有 CS 和没有 CS 的患者短期死亡率较高,但一年后的结果相似。未来的研究应探讨当手术延迟以优化 CS 时,TAVR 的预后是否会得到改善;当无法延迟时,特定的管理策略是否会带来更有利的围手术期预后。
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来源期刊
Cardiovascular Revascularization Medicine
Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.30
自引率
5.90%
发文量
687
审稿时长
36 days
期刊介绍: Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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