Kunadian Babu, Vijayalakshmi Kunadian, Thornley Andrew R, de Belder Mark A, Hunter Steven, Kendall Simon, Graham Richard, Stewart Michael, Thambyrajah Jeetendra, Dunning Joel
The James Cook University Hospital, Middlesbrough, United Kingdom.
Ann Thorac Surg. 2007 Jul;84(1):73-8. doi: 10.1016/j.athoracsur.2007.02.057.
Stentless aortic bioprostheses have been advocated as being superior to conventional bioprosthetic valves, with benefits including superior left ventricular mass regression and larger effective orifice area. Several high-quality randomized studies now exist on this topic, and we sought to summarize them by meta-analysis.
The literature was searched from 1995 to 2006, in MEDLINE, EMBASE, CRISP, metaRegister of Controlled Trials, and the Cochrane database. Experts were also contacted and reference lists searched. Studies were combined using the inverse variance fixed-effects model. Heterogeneity was assessed and a sensitivity analysis performed. Publication bias was also investigated.
Ten studies were identified that included 919 patients in which the Freedom (Sorin Biomedica Cardio, Via Crescentino, Italy), Freestyle (Medtronic, Minneapolis, MN), Prima Plus (Edwards Life Sciences, Irvine, CA) and the Toronto and Biocor (St Jude Medical, St. Paul, MN) valves were used. The mean aortic valve gradient was lower in the stentless groups, with a weighted mean difference (WMD) of -3.57 mm Hg (95% confidence interval [CI], -4.36 to -2.78; p < 0.01). The left ventricular mass index was significantly lower in the stentless groups at 6 months (WMD, -6.42; 95% CI, -11.63 to -1.21; p = 0.02), but this improvement disappeared after 12 months (WMD, 1.19; 95% CI, -4.15 to 6.53; p = 0.66). The weighted mean increase in cross-clamp time was 23 minutes, and the increase in bypass time was 29 minutes with a stentless valve.
This meta-analysis showed that stentless aortic valves provide an improved level of left ventricular mass regression at 6 months, reduced aortic gradients, and an improved effective orifice area index, at the expense of a 23-minute longer cross-clamp time and a 29-minute longer bypass time.
无支架主动脉生物瓣膜被认为优于传统生物瓣膜，其益处包括左心室质量更好地恢复以及有效瓣口面积更大。目前关于该主题已有多项高质量随机研究，我们试图通过荟萃分析对其进行总结。
检索了1995年至2006年MEDLINE、EMBASE、CRISP、对照试验元注册库和Cochrane数据库中的文献。还联系了专家并检索了参考文献列表。采用逆方差固定效应模型合并研究。评估异质性并进行敏感性分析。还调查了发表偏倚。
共确定了10项研究，纳入919例患者，使用了Freedom（索林生物医学心脏公司，意大利克雷申蒂诺）、Freestyle（美敦力公司，明尼阿波利斯，明尼苏达州）、Prima Plus（爱德华兹生命科学公司，尔湾，加利福尼亚州）以及多伦多和Biocor（圣犹达医疗公司，圣保罗，明尼苏达州）瓣膜。无支架组的平均主动脉瓣压差较低，加权平均差（WMD）为-3.57 mmHg（95%置信区间[CI]，-4.36至-2.78；p<0.01）。无支架组在6个月时左心室质量指数显著较低（WMD，-6.42；95%CI，-11.63至-1.21；p = 0.02），但这种改善在12个月后消失（WMD，1.19；95%CI，-4.15至6.53；p = 0.66）。使用无支架瓣膜时，加权平均阻断时间增加23分钟，体外循环时间增加29分钟。
这项荟萃分析表明，无支架主动脉瓣膜在6个月时能更好地使左心室质量恢复，降低主动脉压差，改善有效瓣口面积指数，但代价是阻断时间延长23分钟，体外循环时间延长29分钟。
