经导管与手术主动脉瓣置换术对已有慢性肝病患者的预后：观察性研究的荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-03-28 DOI:10.1016/j.ijcha.2025.101651

Aizaz Ali , Muhammad Abdullah Ali , Asad Iqbal Khattak , Fazia Khattak , Abdullah Afridi , Touba Azeem , Umme Salma Shabbar Banatwala , Umama Alam , Ayesha Khan , Urbe Jalal , Abdul Moeez , Malik W.Z. Khan , Peter Collins , Raheel Ahmed

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引用次数: 0

摘要

慢性肝病，特别是肝硬化和终末期肝病患者的主动脉瓣狭窄，由于心血管和肝功能障碍之间的相互作用，给管理带来了重大挑战。本系统综述和荟萃分析比较了经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术在高危人群中的安全性和有效性。通过对PubMed、Embase和Web of Science的广泛检索（从开始到2025年1月5日），确定了11项回顾性研究，包括19097名患者。使用随机效应模型计算二分类结局的风险比和连续结局的平均差异（MD），每个结果都有95%的置信区间。分析显示，TAVR显著降低医院死亡率(RR 0.36, 95% CI: 0.30-0.42；I2 = 7.6%)，急性肾损伤(RR 0.51, 95% CI: 0.33-0.78；I2 = 57.2%),出血(相对危险度0.33,95%可信区间:0.28 - -0.39;I2 = 0.0%),中风(相对危险度0.35,95%可信区间:0.23 - -0.51;I2 = 6.1%)和输血(RR 0.48, 95% CI: 0.40-0.57；i2 = 7.6%)。TAVR还与较短的住院时间相关(MD为- 6.77天，95% CI: - 9.17至- 4.38；i2 = 97.5%)。在需要手术的血管并发症、住院费用和术后感染方面没有观察到显著差异。这些发现表明，TAVR在减少肝病患者死亡率、急性肾损伤和出血等并发症方面比SAVR具有显著优势。然而，需要进一步的随机试验来确认长期结果，并为这一高危人群建立最佳治疗策略。

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Outcomes of transcatheter vs surgical aortic valve replacement in pre-existing chronic liver disease patients: A meta-analysis of observational studies

Aortic valve stenosis in patients with chronic liver diseases, particularly liver cirrhosis and End-Stage Liver Disease, poses significant management challenges due to the interplay between cardiovascular and hepatic dysfunction. This systematic review and meta-analysis compared the safety and efficacy of Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement in this high-risk population. An extensive search of PubMed, Embase, and Web of Science (inception to January 5, 2025) identified 11 retrospective studies comprising 19,097 patients. Risk ratios for dichotomous outcomes and mean differences (MD) for continuous outcomes, each with 95% confidence intervals, were calculated using random-effects models.

The analysis revealed that TAVR significantly reduced hospital mortality (RR 0.36, 95 % CI: 0.30–0.42; I² = 7.6 %), acute kidney injury (RR 0.51, 95 % CI: 0.33–0.78; I² = 57.2 %), bleeding (RR 0.33, 95 % CI: 0.28–0.39; I² = 0.0 %), stroke (RR 0.35, 95 % CI: 0.23–0.51; I² = 6.1 %), and blood transfusion (RR 0.48, 95 % CI: 0.40–0.57; I² = 7.6 %). TAVR was also associated with shorter hospital stays (MD −6.77 days, 95 % CI: −9.17 to −4.38; I² = 97.5 %). No significant differences were observed in vascular complications requiring surgery or hospital charges and post-operative infections.

These findings suggest TAVR offers significant advantages over SAVR in reducing complications such as mortality, acute kidney injury, and bleeding in patients with liver disease. However, further randomized trials are necessary to confirm long-term outcomes and establish optimal treatment strategies for this high-risk population.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.