严重主动脉瓣狭窄低风险患者经导管主动脉瓣置换术与手术主动脉瓣置换术的长期结果:随机试验的系统回顾和元分析》。

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Rodolfo Caminiti MD , Alfonso Ielasi MD , Giampaolo Vetta MD , Antonio Parlavecchio MD , Domenico Giovanni Della Rocca MD , Mattia Glauber MD , Maurizio Tespili MD , Giampiero Vizzari MD , Antonio Micari MD
{"title":"严重主动脉瓣狭窄低风险患者经导管主动脉瓣置换术与手术主动脉瓣置换术的长期结果:随机试验的系统回顾和元分析》。","authors":"Rodolfo Caminiti MD ,&nbsp;Alfonso Ielasi MD ,&nbsp;Giampaolo Vetta MD ,&nbsp;Antonio Parlavecchio MD ,&nbsp;Domenico Giovanni Della Rocca MD ,&nbsp;Mattia Glauber MD ,&nbsp;Maurizio Tespili MD ,&nbsp;Giampiero Vizzari MD ,&nbsp;Antonio Micari MD","doi":"10.1016/j.amjcard.2024.08.014","DOIUrl":null,"url":null,"abstract":"<div><p>Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for patients with severe aortic stenosis at intermediate or high surgical risk. Results after TAVR in low-risk patients are very encouraging at midterm follow-up, whereas limited long-term (≥3 year) data are available in this subset of patients. This meta-analysis aims to compare the long-term follow-up after TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients. We searched databases up to July 7, 2024 for randomized clinical trials comparing TAVR versus SAVR in low-risk patients (defined as Society of Thoracic Surgeons Predicted Risk of Mortality score &lt;4%) (PROSPERO ID: CRD42023480495). Primary outcome analyzed was all-cause death at a minimum of 3 years of follow-up. The secondary outcomes were cardiovascular death, disabling stroke, myocardial infarction, aortic valve reintervention, endocarditis, new-onset atrial fibrillation, permanent pacemaker implantation, and bioprosthetic valve failure. A total of 3 randomized clinical trials with 2,644 patients (TAVR n = 1,371 patients; SAVR n = 1,273 patients) were included. The follow-up time was 6 ± 2.9 years. TAVR resulted noninferior to SAVR for all-cause death (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.84 to 1.17, p = 0.89, I<sup>2</sup> = 28%), cardiovascular death (RR 0.94, 95% CI 0.76 to 1.15, p = 0.54, I<sup>2</sup> = 0%), myocardial infarction (RR 1.06, 95% CI 0.71 to 1.57, p = 0.79, I<sup>2</sup> = 61%), aortic valve reintervention, endocarditis, and bioprosthetic valve failure. New-onset atrial fibrillation was more common in the SAVR group, whereas permanent pacemaker implantation was more common in the TAVR group. In conclusion, our meta-analysis showed that TAVR is associated with similar long-term outcomes compared with SAVR in selected low-risk patients.</p></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"230 ","pages":"Pages 6-13"},"PeriodicalIF":2.3000,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-Term Results Following Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis of Randomized Trials\",\"authors\":\"Rodolfo Caminiti MD ,&nbsp;Alfonso Ielasi MD ,&nbsp;Giampaolo Vetta MD ,&nbsp;Antonio Parlavecchio MD ,&nbsp;Domenico Giovanni Della Rocca MD ,&nbsp;Mattia Glauber MD ,&nbsp;Maurizio Tespili MD ,&nbsp;Giampiero Vizzari MD ,&nbsp;Antonio Micari MD\",\"doi\":\"10.1016/j.amjcard.2024.08.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for patients with severe aortic stenosis at intermediate or high surgical risk. Results after TAVR in low-risk patients are very encouraging at midterm follow-up, whereas limited long-term (≥3 year) data are available in this subset of patients. This meta-analysis aims to compare the long-term follow-up after TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients. We searched databases up to July 7, 2024 for randomized clinical trials comparing TAVR versus SAVR in low-risk patients (defined as Society of Thoracic Surgeons Predicted Risk of Mortality score &lt;4%) (PROSPERO ID: CRD42023480495). Primary outcome analyzed was all-cause death at a minimum of 3 years of follow-up. The secondary outcomes were cardiovascular death, disabling stroke, myocardial infarction, aortic valve reintervention, endocarditis, new-onset atrial fibrillation, permanent pacemaker implantation, and bioprosthetic valve failure. A total of 3 randomized clinical trials with 2,644 patients (TAVR n = 1,371 patients; SAVR n = 1,273 patients) were included. The follow-up time was 6 ± 2.9 years. TAVR resulted noninferior to SAVR for all-cause death (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.84 to 1.17, p = 0.89, I<sup>2</sup> = 28%), cardiovascular death (RR 0.94, 95% CI 0.76 to 1.15, p = 0.54, I<sup>2</sup> = 0%), myocardial infarction (RR 1.06, 95% CI 0.71 to 1.57, p = 0.79, I<sup>2</sup> = 61%), aortic valve reintervention, endocarditis, and bioprosthetic valve failure. New-onset atrial fibrillation was more common in the SAVR group, whereas permanent pacemaker implantation was more common in the TAVR group. In conclusion, our meta-analysis showed that TAVR is associated with similar long-term outcomes compared with SAVR in selected low-risk patients.</p></div>\",\"PeriodicalId\":7705,\"journal\":{\"name\":\"American Journal of Cardiology\",\"volume\":\"230 \",\"pages\":\"Pages 6-13\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-08-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0002914924006039\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002914924006039","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

摘要

经导管主动脉瓣置换术(TAVR)是一种安全有效的治疗方法,适用于中度或高度手术风险的重度主动脉瓣狭窄患者。低风险患者接受经导管主动脉瓣置换术后的中期随访结果非常令人鼓舞,而这部分患者的长期(≥ 3 年)随访数据却非常有限。本荟萃分析旨在比较低风险患者接受 TAVR 与手术主动脉瓣置换术(SAVR)后的长期随访情况。截至 2024 年 7 月 7 日,我们在数据库中搜索了对低风险患者(定义为 STS-PROM 评分低于 4%)进行 TAVR 与 SAVR 比较的随机临床试验(RCT)。(PERCO ID:CRD42023480495)。分析的主要结果是随访至少3年后的全因死亡。次要结果包括:心血管死亡、致残性中风、心肌梗死(MI)、主动脉瓣再介入、心内膜炎、新发心房颤动、永久起搏器植入(PPI)和生物人工瓣膜功能衰竭(BVF)。共纳入了3项RCT,2644名患者(TAVR,1371名患者;SAVR,1273名患者)。随访时间为 6 ± 2.9 年。在全因死亡[RR:0.99 (95% CI:0.84-1.17;P=0.89;I2=28%)]、心血管死亡[RR:0.94 (95% CI:0.76-1.15;P=0.54;I2=0%)]、心肌梗死[RR:1.06 (95% CI:0.71-1.57;P=0.79;I2=61%)]、主动脉瓣再介入、心内膜炎和BVF方面,TAVR的效果不劣于SAVR。SAVR组的新发心房颤动率较高,而TAVR组的PPI较高。总之,我们的荟萃分析表明,在选定的低风险患者中,TAVR与SAVR相比具有相似的长期疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-Term Results Following Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis of Randomized Trials

Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for patients with severe aortic stenosis at intermediate or high surgical risk. Results after TAVR in low-risk patients are very encouraging at midterm follow-up, whereas limited long-term (≥3 year) data are available in this subset of patients. This meta-analysis aims to compare the long-term follow-up after TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients. We searched databases up to July 7, 2024 for randomized clinical trials comparing TAVR versus SAVR in low-risk patients (defined as Society of Thoracic Surgeons Predicted Risk of Mortality score <4%) (PROSPERO ID: CRD42023480495). Primary outcome analyzed was all-cause death at a minimum of 3 years of follow-up. The secondary outcomes were cardiovascular death, disabling stroke, myocardial infarction, aortic valve reintervention, endocarditis, new-onset atrial fibrillation, permanent pacemaker implantation, and bioprosthetic valve failure. A total of 3 randomized clinical trials with 2,644 patients (TAVR n = 1,371 patients; SAVR n = 1,273 patients) were included. The follow-up time was 6 ± 2.9 years. TAVR resulted noninferior to SAVR for all-cause death (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.84 to 1.17, p = 0.89, I2 = 28%), cardiovascular death (RR 0.94, 95% CI 0.76 to 1.15, p = 0.54, I2 = 0%), myocardial infarction (RR 1.06, 95% CI 0.71 to 1.57, p = 0.79, I2 = 61%), aortic valve reintervention, endocarditis, and bioprosthetic valve failure. New-onset atrial fibrillation was more common in the SAVR group, whereas permanent pacemaker implantation was more common in the TAVR group. In conclusion, our meta-analysis showed that TAVR is associated with similar long-term outcomes compared with SAVR in selected low-risk patients.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
American Journal of Cardiology
American Journal of Cardiology 医学-心血管系统
CiteScore
4.00
自引率
3.60%
发文量
698
审稿时长
33 days
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.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信