Phan Kevin, Zhao Dong-Fang, Wang Nelson, Huo Ya Ruth, Di Eusanio Marco, Yan Tristan D
1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Cardiac Surgery Unit Cardiovascular Department 'G. Mazzini' Hospital Piazza Italia, 64100 Teramo, Italy.
J Thorac Dis. 2016 Jan;8(1):E83-93. doi: 10.3978/j.issn.2072-1439.2016.01.44.
Transcatheter valve-in-valve (VIV) implantation for degenerated aortic bioprostheses has emerged as a promising alternative to redo conventional aortic valve replacement (cAVR). However there are concerns surrounding the efficacy and safety of VIV. This systematic review aims to compare the outcomes and safety of transcatheter VIV implantation with redoes cAVR. Six databases were systematically searched. A total of 18 relevant studies (823 patients) were included. Pooled analysis demonstrated VIV achieved significant improvements in mean gradient (38 mmHg preoperatively to 15.2 mmHg postoperatively, P<0.001) and peak gradient (59.2 to 23.2 mmHg, P=0.0003). These improvements were similar to the outcomes achieved by cAVR. The incidence of moderate paravalvular leaks (PVL) were significantly higher for VIV compared to cAVR (3.3% vs. 0.4%, P=0.022). In terms of morbidity, VIV had a significantly lower incidence of stroke and bleeding compared to redo cAVR (1.9% vs. 8.8%, P=0.002 & 6.9% vs. 9.1%, P=0.014, respectively). Perioperative mortality rates were similar for VIV (7.9%) and redo cAVR (6.1%, P=0.35). In conclusion, transcatheter VIV implantation achieves similar haemodynamic outcomes, with lower risk of strokes and bleeding but higher PVL rates compared to redo cAVR. Future randomized studies and prospective registries are essential to compare the effectiveness of transcatheter VIV with cAVR, and clarify the rates of PVLs.
经导管主动脉瓣生物瓣衰败后的瓣中瓣（VIV）植入术已成为再次进行传统主动脉瓣置换术（cAVR）的一种有前景的替代方法。然而，VIV的疗效和安全性仍存在一些问题。本系统评价旨在比较经导管VIV植入术与再次cAVR的疗效和安全性。系统检索了六个数据库。共纳入18项相关研究（823例患者）。汇总分析表明，VIV术后平均跨瓣压差（术前38 mmHg降至术后15.2 mmHg，P<0.001）和峰值跨瓣压差（59.2至23.2 mmHg，P=0.0003）均有显著改善。这些改善与cAVR的结果相似。与cAVR相比，VIV术后中度瓣周漏（PVL）的发生率显著更高（3.3% vs. 0.4%，P=0.022）。在并发症方面，与再次cAVR相比，VIV术后卒中及出血的发生率显著更低（分别为1.9% vs. 8.8%，P=0.002；6.9% vs. 9.1%，P=0.014）。VIV和再次cAVR的围手术期死亡率相似（分别为7.9%和6.1%，P=0.35）。总之，与再次cAVR相比，经导管VIV植入术能获得相似的血流动力学结果，卒中及出血风险更低，但PVL发生率更高。未来的随机研究和前瞻性注册研究对于比较经导管VIV与cAVR的有效性以及明确PVL发生率至关重要。
