低危患者经导管主动脉瓣置换术：随机对照试验的最新荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-05-03 DOI:10.1016/j.ijcha.2025.101692

Roel Meeus , Pavell Dhondt , Jesslyn Hariyanto , Hadiah Ashraf , Caterina Lecchi , Caroline O. Fischer-Bacca , Leen Van Langenhoven , Lennert Minten , Christophe Dubois

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引用次数: 0

摘要

背景经导管主动脉瓣置换术（TAVR）越来越多地用于低风险的主动脉瓣狭窄（AS）患者的手术主动脉瓣置换术（SAVR），尽管中期和长期临床结果不确定。目的：我们进行了一项更新的荟萃分析，比较该人群的TAVR和SAVR。方法：我们检索PubMed、EMBASE和Cochrane Central检索比较TAVR和SAVR在低危双尖或三尖AS患者中的疗效的随机对照试验（RCT）。随访30天、1年和长达5年的结果为全因死亡率、再住院和卒中。结果纳入6项随机对照试验，共4487例患者，平均年龄74.2±5.5岁，其中50.1%的患者行TAVR。TAVR和SAVR的STS-PROM评分相似（2.1±0.7 vs 2.2±0.8%）。30天全因死亡率呈现边缘性显著差异，有利于TAVR (RR 0.55；95% ci 0.30-1.01；p = 0.05)。TAVR患者一年全因死亡率显著降低(RR 0.60；95% ci 0.41-0.98；p = 0.01)，而5年随访无差异(RR 1.02；95% ci 0.81-1.29；p = 0.85)。TAVR与减少30天相关(RR 0.67；95% ci 0.46-0.95；p = 0.03)和1年再住院率(RR 0.72；95% ci 0.53-0.98；p = 0.04)。30天卒中发生率(RR 0.78；95% ci 0.48-1.32；p = 0.37)， 1年(RR 0.79；95% ci 0.48-1.32；p = 0.37)和5年随访(RR 1.09；95% ci 0.81-1.46；P = 0.56)，差异无统计学意义。结论与SAVR相比，低危AS患者的1年全因死亡率和再住院率均降低。这种益处在长期随访中减弱。

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Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials

Background

Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic valve stenosis (AS) at low risk for surgical aortic valve replacement (SAVR), despite uncertainty regarding medium and long-term clinical outcomes.

Objectives

We performed an updated meta-analysis comparing TAVR with SAVR in this population.

Methods

We searched PubMed, EMBASE and Cochrane Central for randomized controlled trials (RCT) comparing TAVR with SAVR in low-risk patients with either bicuspid or tricuspid AS. Outcomes of interest were all-cause mortality, rehospitalization and stroke at 30 days, 1 year and up to 5 years follow-up.

Results

We included six RCTs with in total 4487 patients, mean age 74.2 ± 5.5y and of which 50.1 % underwent TAVR. The STS-PROM Score was similar for TAVR and SAVR (2.1 ± 0.7 vs. 2.2 ± 0.8 %). Thirty-day all-cause mortality showed a borderline significant difference favoring TAVR (RR 0.55; 95 % CI 0.30–1.01; p = 0.05). One-year all-cause mortality was significantly lower for TAVR (RR 0.60; 95 % CI 0.41–0.98; p = 0.01), while no differences were seen at 5-year follow up (RR 1.02; 95 % CI 0.81–1.29; p = 0.85). TAVR was associated with reduced 30-day (RR 0.67; 95 % CI 0.46–0.95; p = 0.03) and one-year rehospitalization rates (RR 0.72; 95 % CI 0.53–0.98; p = 0.04). Stroke rates at 30 days (RR 0.78; 95 % CI 0.48–1.32; p = 0.37), one-year (RR 0.79; 95 % CI 0.48–1.32; p = 0.37) and 5-year follow-up (RR 1.09; 95 % CI 0.81–1.46; p = 0.56) were not significantly different.

Conclusions

TAVR in low-risk patients with AS results in reduced 1-year all-cause mortality and rehospitalization rates as compared with SAVR. This benefit is attenuated during protracted follow-up.

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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.