心脏移植后右束支传导阻滞的预测因素和预后：系统回顾和荟萃分析。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-09-16 DOI:10.1111/ctr.70322

Naydeen Mostafa, Omar Almaadawy, Ahmed Elshahat, Muhiddin Dervis, Belal Mohamed Hamed, Amar Asad, Sofian Zreigh, Esraa M. Soliman, Hamed Abdelma'aboud Mostafa, Hossam Elbenawi, Mustafa Ahmed

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引用次数: 0

摘要

背景：右束分支阻滞（RBBB）在心脏移植受者中发病率很高，并可能影响预后。至关重要的是，心脏移植后RBBB发展的预测因素尚不完善。本研究旨在评估心脏移植术后RBBB的术前预测因素和预后。方法：检索截至2024年11月15日的PubMed、Scopus、Web of Science和Cochrane Library，以确定比较RBBB和非RBBB心脏移植受者的研究。随机效应模型以95%置信区间（95% ci）估计合并平均差（MD）和风险比（rr）。结果：9项研究纳入1507例患者。发生RBBB的患者移植物缺血时间更长[MD: 10.0；95% ci: 2.00-17.91；肺血管阻力（PVR）（MD: 0.44; 95% CI: 0.21-0.68; p < 0.001）。RBBB患者与非RBBB患者在肺动脉压（MD: 1.83; 95% CI: -0.86-4.53; p = 0.18）或供体年龄（MD: 1.51; 95% CI: -0.30- 3.31; p = 0.10）方面无显著差异。RBBB患者在急性排斥反应（RR: 1.06; 95% CI: 0.70-1.61; p = 0.78）、慢性排斥反应（RR: 0.92; 95% CI: 0.60-1.41; p = 0.70）或死亡率（RR: 1.87; 95% CI: 0.81-4.31; p = 0.14）方面的预后无显著差异。结论：尽管RBBB与移植物缺血时间和PVR相关，但移植后RBBB对死亡率和移植排斥反应无显著影响。建议进一步研究RBBB的识别期和应用定义。

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Predictors and Prognosis of Right Bundle Branch Block Following Heart Transplantation: A Systematic Review and Meta-Analysis

Background

Right bundle branch block (RBBB) has a high prevalence among heart transplant recipients and could influence outcomes. Crucially, the predictors of RBBB development after heart transplantation are not well-established. Our study aims to evaluate the preoperative predictors and outcomes of RBBB following heart transplantation.

Methods

PubMed, Scopus, Web of Science, and Cochrane Library were searched up to November 15, 2024, to identify studies comparing heart transplant recipients with RBBB and without RBBB. Random-effects models were used to estimate the pooled mean difference (MD) and risk ratios (RRs) with 95% confidence intervals (95% CIs).

Results

Nine studies incorporating 1507 patients were included. Patients who developed RBBB had higher graft ischemia time [MD: 10.0; 95% CI: 2.00–17.91; p = 0.01] and pulmonary vascular resistance (PVR) (MD: 0.44; 95% CI: 0.21–0.68; p < 0.001). There was no significant difference between RBBB and non-RBBB patients in terms of pulmonary artery pressure (MD: 1.83; 95% CI: -0.86–4.53; p = 0.18) or donor age (MD: 1.51; 95% CI: -0.30– 3.31; p = 0.10). There was no significant difference in the prognosis of RBBB patients in terms of acute rejection (RR: 1.06; 95% CI: 0.70–1.61; p = 0.78), chronic rejection (RR: 0.92; 95% CI: 0.60–1.41; p = 0.70), or mortality (RR: 1.87; 95% CI: 0.81–4.31; p = 0.14).

Conclusion

Despite the association of RBBB with graft ischemia time and PVR, post-transplant RBBB had no significant impact on mortality or graft rejection. Further research focusing on the identification period and applied definition of RBBB is recommended.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.