Luo X, Zhao Z, Chai H, Zhang C, Liao Y, Li Q, Peng Y, Liu W, Ren X, Meng Q, Chen C, Chen M, Feng Y, Huang D
Department of Cardiology, West China Hospital of Sichuan University, No.37 Guo Xue Xiang of Wuhou District, 610041, Chengdu, Sichuan, P.R. China.
Herz. 2015 Apr;40 Suppl 2:168-80. doi: 10.1007/s00059-014-4193-z. Epub 2015 Feb 26.
Transcatheter aortic valve implantation (TAVI) is safe and effective for patients with aortic stenosis (AS) who have a high operative risk. However, there is still debate on the effect of TAVI in AS patients with reduced left ventricular ejection fraction (REF). The objective of the review is to clarify the efficacy of TAVI and the impact of REF on the 30-day and midterm mortality in these patients.
Studies on TAVI were searched in PubMed, Embase, and the Cochrane Library databases and were included in this review following predefined criteria. Data were extracted and pooled risk ratios (RR) were synthesized to explore the relationship between REF and 30-day plus midterm mortality.
Twenty-eight studies comprising 14,099 patients were included in the analysis of the association of REF with the prognosis of patients after TAVI. An average increase in left ventricular ejection fraction of 8-10 % was observed among these patients after TAVI. REF was not related to the 30-day mortality [RR = 1.90, 95 % confidence interval (CI) = 0.80-4.47]; however, it was related to the midterm mortality (RR = 1.49, 95 %CI = 1.14-1.93) of patients undergoing TAVI. Patients with low-flow and low-gradient AS had a higher 30-day mortality (RR = 1.54, 95 %CI = 1.11-2.13) and midterm mortality rate (RR = 1.69, 95 %CI = 1.33-2.14) compared with AS patients without these characteristics. The mortality of TAVI patients was significantly lower than that of those undergoing conservative therapy, and was similar to that of patients undergoing surgical aortic valve replacement.
REF was not associated with 30-day mortality, but it was associated with the midterm mortality of TAVI patients. Patients with REF could benefit from TAVI compared with conservative therapy.
经导管主动脉瓣植入术（TAVI）对于手术风险高的主动脉瓣狭窄（AS）患者是安全有效的。然而，TAVI对左心室射血分数（REF）降低的AS患者的影响仍存在争议。本综述的目的是阐明TAVI的疗效以及REF对这些患者30天和中期死亡率的影响。
在PubMed、Embase和Cochrane图书馆数据库中检索关于TAVI的研究，并按照预定义标准纳入本综述。提取数据并合成合并风险比（RR），以探讨REF与30天加中期死亡率之间的关系。
28项研究共纳入14099例患者，用于分析REF与TAVI术后患者预后的相关性。这些患者TAVI术后左心室射血分数平均增加8%-10%。REF与30天死亡率无关[RR = 1.90，95%置信区间（CI）= 0.80-4.47]；然而，它与接受TAVI患者的中期死亡率相关（RR = 1.49，95%CI = 1.14-1.93）。与无这些特征的AS患者相比，低流量低梯度AS患者的30天死亡率（RR = 1.54，95%CI = 1.11-2.13）和中期死亡率更高（RR = 1.69，95%CI = 1.33-2.14）。TAVI患者的死亡率显著低于接受保守治疗的患者，且与接受外科主动脉瓣置换术的患者相似。
REF与30天死亡率无关，但与TAVI患者的中期死亡率有关。与保守治疗相比，REF患者可从TAVI中获益。
