Comparative Outcomes of TAVR in Mixed Aortic Valve Disease and Aortic Stenosis: A Meta-analysis.
IF 3
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
引用次数: 0
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has become a suitable alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). A high proportion of patients with AS have mixed aortic valve disease (MAVD) with mild or more concurrent aortic regurgitation (AR). Differential outcomes of TAVR among patients with AS and MAVD have not been well characterized. We compared 1-year mortalities following TAVR among patients with MAVD and AS.
Methods: We conducted a meta-analysis of studies published in PubMed/Medline. The primary outcome was 1-year all-cause mortality following TAVR among patients with MAVD vs. AS. Secondary endpoints were: (1) incidence of AR within 30 days following TAVR (post TAVR AR); and (2) 1-year all-cause mortality within each group stratified according to severity of post TAVR AR.
Results: Nine studies involving 9505 participants were included in the analysis. At 1 year following TAVR, mortality was lower in MAVD than in AS; HR 0.89, 95% CI 0.81-0.98. The mortality advantage increased when pre-TAVR AR was moderate or more; HR 0.84, 95% CI 0.72-0.99. The mortality advantage was attenuated after correction for publication bias. There was a higher risk of post TAVR AR in the MAVD group; OR 1.51, 95% CI 1.20-1.90 but the impact on mortality of moderate vs. mild post TAVR AR was greater among patients with AS than in patients with MAVD HR 1.67 95% CI 0.89-3.14 vs. 0.93 95% CI 0.47-1.85.
Conclusions: Patients with MAVD have similar or improved survival 1 year after TAVR compared to those with AS.
混合性主动脉瓣病和主动脉瓣狭窄的 TAVR 结果比较：一项 Meta 分析。
导言：经导管主动脉瓣置换术（TAVR）已成为治疗无症状重度主动脉瓣狭窄（AS）的手术主动脉瓣置换术（SAVR）的合适替代方案。很大一部分主动脉瓣狭窄患者患有混合性主动脉瓣疾病（MAVD），并伴有轻度或更严重的主动脉瓣反流（AR）。TAVR在AS和MAVD患者中的不同疗效尚未得到很好的描述。我们比较了MAVD和AS患者TAVR术后1年的死亡率：我们对发表在PubMed/Medline上的研究进行了荟萃分析。主要结果是 MAVD 与 AS 患者 TAVR 术后 1 年的全因死亡率。次要终点为(1) TAVR 术后 30 天内 AR 的发生率（TAVR 术后 AR）；(2) 根据 TAVR 术后 AR 的严重程度分层的各组 1 年全因死亡率：共有9项研究纳入分析，涉及9505名参与者。TAVR术后1年，MAVD患者的死亡率低于AS患者；HR为0.89，95% CI为0.81-0.98。当TAVR前AR为中度或以上时，死亡率优势增加；HR为0.84，95% CI为0.72-0.99。校正发表偏倚后，死亡率优势有所减弱。MAVD组发生TAVR后AR的风险较高；OR 1.51，95% CI 1.20-1.90，但中度与轻度TAVR后AR对AS患者死亡率的影响大于MAVD患者：与 AS 患者相比，MAVD 患者在 TAVR 术后 1 年的生存率相似或更高。
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来源期刊
Cardiology and Therapy
CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.30
自引率
0.00%
发文量
38
审稿时长
6 weeks
期刊介绍：
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Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged.
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