Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
Am J Cardiol. 2013 Sep 15;112(6):850-60. doi: 10.1016/j.amjcard.2013.05.015. Epub 2013 Jun 4.
The purpose of this meta-analysis was to compare postprocedural mortality and major adverse cardiovascular and cerebrovascular events between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for severe aortic stenosis. Seventeen studies (n = 4,659) comparing TAVI (n = 2,267) and SAVR (n = 2,392) were included. End points were baseline logistic European System for Cardiac Operative Risk Evaluation score, all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, transient ischemic attack, and major bleeding events. Mean differences or risk ratios with 95% confidence intervals were computed, and p values <0.05 were considered significant. The population was matched for risk between the 2 groups on the basis of logistic European System for Cardiac Operative Risk Evaluation score for all outcomes except 30-day all-cause mortality, which had a high-risk population in the TAVI group (p = 0.02). There was no significant difference found in all-cause mortality at 30 days (p = 0.97) and at an average of 85 weeks (p = 0.07). There was no significant difference in cardiovascular mortality (p = 0.54) as well as the incidence of myocardial infarction (p = 0.59), stroke (p = 0.36), and transient ischemic attack (p = 0.85) at averages of 86, 72, 66, and 89 weeks, respectively. Compared with patients who underwent TAVI, those who underwent SAVR had a significantly higher frequency of major bleeding events (p <0.0001) at mean follow-up of 66 weeks. In conclusion, TAVI has similar cardiovascular and all-cause mortality to SAVR at early and long-term follow-up. TAVI is superior to SAVR for major bleeding complications and noninferior to SAVR for postprocedural myocardial infarctions and cerebrovascular events. TAVI is a safe alternative to SAVR in selected high-risk elderly patients with severe aortic stenosis.
本荟萃分析旨在比较经导管主动脉瓣植入术（TAVI）与外科主动脉瓣置换术（SAVR）治疗重度主动脉瓣狭窄的术后死亡率和主要不良心血管和脑血管事件。纳入了 17 项比较 TAVI（n=2267）和 SAVR（n=2392）的研究。终点包括基线逻辑欧洲心脏手术风险评估评分、全因死亡率、心血管死亡率、心肌梗死、卒中和短暂性脑缺血发作以及大出血事件。计算了均值差异或风险比及其 95%置信区间，p 值<0.05 认为差异有统计学意义。基于逻辑欧洲心脏手术风险评估评分，两组人群在所有结局上风险匹配，除了 30 天全因死亡率，TAVI 组的死亡率高（p=0.02）。30 天全因死亡率（p=0.97）和平均 85 周全因死亡率（p=0.07）无显著差异。心血管死亡率（p=0.54）、心肌梗死发生率（p=0.59）、卒中和短暂性脑缺血发作发生率（p=0.36）也无显著差异，分别在平均 86、72、66 和 89 周随访时评估。与接受 TAVI 的患者相比，接受 SAVR 的患者在平均 66 周的随访中主要出血事件的发生率显著更高（p<0.0001）。总之，TAVI 在早期和长期随访中与 SAVR 的心血管和全因死亡率相似。TAVI 在大出血并发症方面优于 SAVR，在术后心肌梗死和脑血管事件方面不劣于 SAVR。TAVI 是一种安全的替代方法，适用于选定的高危老年重度主动脉瓣狭窄患者。
