Ricardo F O Suruagy-Motta, Luiz Guilherme Silva Almeida, Julia Tirelli-Rocha, Gabriel Rezende Neves, Rafael Batista Félix, Robert K White, Kalgi Modi, Gregg W Stone
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引用次数: 0
Abstract
Background: Tricuspid valve infective endocarditis (TVIE) is increasingly prevalent, especially among intravenous drug users. Surgical intervention is the standard treatment for severe cases, but percutaneous mechanical aspiration (PMA) has emerged as a less invasive alternative in high-risk patients. Comparative data on both strategies remain limited.
Objectives: To evaluate the safety and efficacy of PMA versus surgical management in patients with TVIE through a systematic review and meta-analysis.
Methods: A comprehensive search of five databases (PubMed, Embase, Cochrane, Web of Science, Scopus) through July 2025 identified studies comparing PMA and surgery for TVIE. Outcomes included all-cause mortality (30-day and 1-year), hospital length of stay, in-hospital mortality, and readmission for endocarditis. Risk ratios (RR) and mean differences (MD) were pooled using a random-effects model. Risk of bias was assessed using ROBINS-I.
Results: Ten retrospective studies involving 6,035 patients were included (974 treated with PMA and 5,061 treated with surgery). The risk of in-hospital mortality was similar between PMA and surgery (RR=1.07; p=0.91). PMA was associated with a higher risk for 30-day mortality (RR=2.71; 95% CI: 1.53-4.82; p<0.001) but not for 1-year mortality (RR=1.13; 95% CI: 0.72-1.77; p=0.60) or readmission for endocarditis (RR=0.82; p=0.63) compared with surgery. PMA was also associated with a shorter hospital stay (MD=-7.0 days; 95% CI: -13.0 to -1.1; p=0.03). The risk of bias was moderate to serious in all studies.
Conclusions: In conclusion, the present systematic review of ten retrospective studies, surgical management of TVIE was associated with better short-term survival compared with PMA although the risks of 1-year mortality and readmission were similar. Randomized trials are required to better define the risk benefit profile of these approaches to TVIE.
背景：三尖瓣感染性心内膜炎（TVIE）越来越普遍，特别是在静脉吸毒者中。手术干预是严重病例的标准治疗方法，但经皮机械抽吸（PMA）已成为高风险患者侵入性较小的替代方法。关于这两种战略的比较数据仍然有限。目的：通过系统回顾和荟萃分析，评估PMA与手术治疗TVIE患者的安全性和有效性。方法：到2025年7月，对5个数据库（PubMed, Embase, Cochrane, Web of Science, Scopus）进行全面检索，确定了比较PMA和手术治疗TVIE的研究。结果包括全因死亡率（30天和1年）、住院时间、住院死亡率和心内膜炎再入院。采用随机效应模型合并风险比（RR）和平均差异（MD）。使用ROBINS-I评估偏倚风险。结果：纳入10项回顾性研究，涉及6035例患者（974例采用PMA治疗，5061例采用手术治疗）。PMA和手术的院内死亡风险相似（RR=1.07; p=0.91）。结论：本研究对10项回顾性研究进行了系统回顾，尽管TVIE的1年死亡率和再入院风险相似，但与PMA相比，TVIE的手术治疗与更好的短期生存率相关。需要随机试验来更好地定义这些TVIE方法的风险-收益概况。
期刊介绍：
Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.
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