Xie Xiaochuan, Shi Xiaohan, Xun Xiaoshuang, Rao Li
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Ann Thorac Cardiovasc Surg. 2016 Aug 23;22(4):203-15. doi: 10.5761/atcs.ra.16-00032. Epub 2016 Apr 20.
To elucidate the performance of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) patients through a systematic review and meta-analysis.
A systematic literature review was performed by searching eligible articles in PubMed, Medline, EMBASE, Google Scholar and CNKI. Meta-analysis of included case-control/cohort studies was further conducted. Relative risks (RRs) and the corresponding 95% confidence intervals (CIs) were used to compare clinical outcomes of BAV patients and non-BAV patients.
A total of 17 articles including eight case reports, four case series and five case-control/cohort studies with 166 BAV patients were analyzed. Device success rate achieved for TAVI in this cohort of BAV patients was 95.2%. The 30-day mortality rate was 8.4%, and the medium-term (range from 6 months to 2 years) mortality rate reported was 17.9%. Overall, the performance of TAVI in BAV patients was comparable to that in non-BAV patients, as reported by the included case-control/cohort studies (30-day mortality rate: RR = 1.05, 95%CI 0.57-1.95, p = 0.87; Device success rate: RR = 1.00, 95%CI 0.95-1.05, p = 0.94; Incidence of moderate to severe paravalvular regurgitation: RR = 1.25, 95%CI 0.85-1.84, p = 0.25).
The present study suggested that TAVI may be a feasible and safe treatment modality for BAV patients.
通过系统评价和荟萃分析阐明经导管主动脉瓣植入术(TAVI)在二叶式主动脉瓣(BAV)患者中的疗效。
通过检索PubMed、Medline、EMBASE、谷歌学术和中国知网中的符合条件的文章进行系统文献综述。对纳入的病例对照/队列研究进一步进行荟萃分析。采用相对风险(RRs)及相应的95%置信区间(CIs)比较BAV患者和非BAV患者的临床结局。
共分析了17篇文章,包括8篇病例报告、4篇病例系列和5篇病例对照/队列研究,涉及166例BAV患者。该队列BAV患者中TAVI的器械成功率为95.2%。30天死亡率为8.4%,报告的中期(6个月至2年)死亡率为17.9%。总体而言,纳入的病例对照/队列研究报告显示,BAV患者中TAVI的疗效与非BAV患者相当(30天死亡率:RR = 1.05,95%CI 0.57 - 1.95,p = 0.87;器械成功率:RR = 1.00,95%CI 0.95 - 1.05,p = 0.94;中重度瓣周反流发生率:RR = 1.25,95%CI 0.85 - 1.84,p = 0.25)。
本研究提示TAVI可能是BAV患者一种可行且安全的治疗方式。