心脏手术中预防性合并左心耳闭塞的临床影响:一项系统回顾和荟萃分析

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Chengji Zhao , Evaldas Girdauskas , Jan W. Schoones , Robert J.M. Klautz , Meindert Palmen , Anton Tomšič
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引用次数: 0

摘要

最近,合并左心耳闭塞(LAAO)已成为预防无房颤病史的心脏手术患者血栓栓塞事件的预防性治疗选择。预防性LAAO的疗效尚不清楚。方法检索spubmed、Embase、Web of Science、Emcare和Cochrane Library,检索心脏手术患者预防性LAAO的相关研究。主要终点是术后血栓栓塞并发症和术后心房颤动(POAF)。结果纳入3项随机试验和7项回顾性观察性研究:7369例患者在心脏手术期间接受了预防性LAAO (n = 3823)或未接受预防性LAAO (n = 3546)。预防性LAAO使早期血栓栓塞事件的风险降低58%(风险比:0.42;95%置信区间:0.25 ~ 0.73;p = 0.002;I2 = 0%),估计绝对风险降低0.8%。另一方面,LAAO患者发生POAF的风险更高,尽管没有统计学意义(风险比:1.15;95%置信区间:1.00 ~ 1.32;p = 0.051;i2 = 64%)。预防性LAAO还将血栓栓塞并发症的风险降低了52%(危险比:0.48;95% CI: 0.29 ~ 0.80;p = 0.005;i2 = 41%)。结论预防性LAAO与早期和全部血栓栓塞事件的减少有关,但与POAF的高风险有潜在关系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The clinical impact of prophylactic concomitant left atrial appendage occlusion during cardiac surgery: A systematic review and meta-analysis

Background

Recently, concomitant left atrial appendage occlusion (LAAO) has emerged as prophylactic treatment option for preventing thromboembolic events in patients undergoing cardiac surgery with no known history of atrial fibrillation. The efficacy of prophylactic LAAO remains unknown.

Methods

PubMed, Embase, Web of Science, Emcare, and the Cochrane Library were searched for studies on prophylactic LAAO in patients undergoing cardiac surgery. The primary endpoints were postoperative thromboembolic complications and postoperative atrial fibrillation (POAF).

Results

Three randomized trials and seven retrospective observational studies were included: in total, 7369 patients received either prophylactic LAAO (n = 3823) or no prophylactic LAAO (n = 3546) during their index cardiac surgery. Prophylactic LAAO reduced the risk of early thromboembolic events by 58 % (risk ratio: 0.42; 95 % confidence interval: 0.25 to 0.73; p = 0.002; I2 = 0 %) with an estimated absolute risk reduction of 0.8 %. On the other hand, a higher risk, albeit statistically not significant, of POAF was seen with LAAO (risk ratio: 1.15; 95 % confidence interval: 1.00 to 1.32; p = 0.051; I2 = 64 %). Prophylactic LAAO also reduced the risk of all-time thromboembolic complications by 52 % (hazards ratio: 0.48; 95 % CI: 0.29 to 0.80; p = 0.005; I2 = 41 %).

Conclusion

Prophylactic LAAO was associated with a reduction in early and all-time thromboembolic events but demonstrated a potential relation to a higher risk of POAF.
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CiteScore
1.60
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