高梯度与低射血分数、低梯度重度主动脉瓣狭窄患者的经导管主动脉瓣置换术结果：随机对照试验荟萃分析。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine Pub Date : 2025-04-01 DOI:10.1016/j.carrev.2024.07.020

Asseel Al-Bayati , Abdullah Alrifai , Fahed Darmoch , Haytham Alkhaimy , Zaher Fanari

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引用次数: 0

摘要

背景：接受经导管主动脉瓣置换术（TAVR）的低流量-低梯度（LF-LG）重度主动脉瓣狭窄（AS）患者的预后尚不明确。我们对文献进行了系统性回顾，以比较 LF-LG AS 患者与更传统的高梯度（HG）主动脉瓣狭窄患者接受 TAVR 的疗效：我们从 4 个在线数据库中全面检索了对照随机和非随机研究。我们使用风险比（95 % 置信区间）来展示数据，并使用希金斯 I2 指数来衡量异质性：我们的分析包括来自 6 项队列研究（5 项回顾性研究和 1 项前瞻性研究）的 4380 名患者，其中有 3425 名 HG 患者和 955 名 LF-LG 患者。与 LFLG 相比，TAVR 可显著降低 HG 患者的 30 天死亡率（5.1% vs 7.4%；相对风险 [RR]： 0.55；95% 置信区间）：0.55; 95 %置信区间 [CI]：结论和相关性：接受TAVR的LF-LG重度AS患者的1年全因死亡率、30天全因死亡率和1年CV死亡率均低于接受TAVR的HG重度AS患者。心肌梗死或中风的发生率没有差异。因此，通过心脏团队的讨论和患者对风险和获益的知情决定，TAVR与保守治疗相比，仍能为LFLG AS提供更好的治疗效果。

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Transcatheter aortic valve replacement outcomes in patients with high gradient versus low ejection fraction low gradient severe aortic stenosis: A meta-analysis of randomized controlled trials

Background

The outcome of Low Flow-Low Gradient (LF-LG) severe aortic stenosis (AS) patients who underwent Transcatheter Aortic Valve Replacement (TAVR) procedure is not well defined. We conducted a systematic review of the literature to compare the outcomes of TAVR in LF-LG AS patients to the more traditional high gradient (HG) aortic stenosis.

Methods

We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We are presenting the data using risk ratios (95 % confidence intervals) and measuring heterogeneity using Higgins' I² index.

Results

Our analysis included 4380 patients with 3425 HG patients and 955 LF-LG patients from 6 cohort (5 retrospective and 1 prospective) studies. When compared to LFLG; TAVR was associated with significantly lower 30 days mortality in HG patients (5.1 % vs 7.4 %; relative risk [RR]: 0.55; 95 % confidence interval [CI]: 0.35 to 0.86; p < 0.01). Similar findings were also observed in 12-month cardiovascular (CV) mortality (5.5 % vs. 10.4 %; RR: 0.47; 95 % CI: 0.38 to 0.60; p < 0.01 and 12-month all-cause mortality (15.9 % vs 20.9 %; RR: 0.70; 95 % CI: 0.49 to 1.00; p < 0.05). There was no significant difference in myocardial infarction (MI) after TAVR between HG and LF-LG at 30 days (0.16 % vs. 0.95 %; p < 0.09) or 12 months (0.43 % vs. 0.95 %; p = 0.20). Similarly, there was no difference in stroke rates at 30 days (2.9 % vs. 2.86 %) or at 12 months (3.6 % vs. 3.06 %).

Conclusions and relevance

Patients with LF-LG severe AS who underwent TAVR had worse 1-year all-cause mortality, 30-day all-cause, and 1-year CV mortality when compared to TAVR in HG severe AS. There was no difference in MI or stroke rates. Therefore, with heart team discussion and informed patient decision regarding the risk and benefit, TAVR would still offer better outcomes in LFLG AS compared to conservative medical management.

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来源期刊

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.