Centro Cardiologico Monzino IRCCS, Milan, Italy
Centro Cardiologico Monzino IRCCS, Milan, Italy Dipartimento di Medicina e Chirurgia, University of Milan, Italy.
J Am Heart Assoc. 2016 May 18;5(5):e003200. doi: 10.1161/JAHA.116.003200.
Literature studies suggested a lower prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) than in tricuspid aortic valve (TAV) patients. However, this finding has been challenged. We performed a meta-analysis to assess whether aortic valve morphology has a different association with CAD, concomitant coronary artery bypass grafting (CABG), and postoperative mortality.
Detailed search was conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline to identify all patients with BAV or TAV and presence of CAD, concomitant myocardial surgical revascularization, and the postoperative mortality. Thirty-one studies on 3017 BAV and 4586 TAV patients undergoing aortic valve surgery were included. BAV patients showed a lower prevalence of CAD (odds ratio [OR]: 0.33; 95% CI: 0.17, 0.65), concomitant CABG (OR, 0.45; 95% CI: 0.35, 0.59), and postoperative mortality (OR, 0.62; 95% CI: 0.40, 0.97) than TAV. However, BAV subjects were significantly younger than TAV (mean difference: -7.29; 95% CI: -11.17, -3.41) were more frequently males (OR, 1.61; 95% CI: 1.33, 1.94) and exhibited a lower prevalence of hypertension (OR, 0.58; 95% CI: 0.39, 0.87) and diabetes (OR, 0.71; 95% CI: 0.54, 0.93). Interestingly, a metaregression analysis showed that younger age and lower prevalence of diabetes were associated with lower prevalence of CAD (Z value: -3.03; P=0.002 and Z value: -3.10; P=0.002, respectively) and CABG (Z value: -2.69; P=0.007 and Z value: -3.36; P=0.001, respectively) documented in BAV patients.
Analysis of raw data suggested an association of aortic valve morphology with prevalence of CAD, concomitant CABG, and postoperative mortality. Interestingly, the differences in age and diabetes have a profound impact on prevalence of CAD between BAV and TAV. In conclusion, our meta-analysis suggests that the presence of CAD is independent of aortic valve morphology.
文献研究表明，二叶式主动脉瓣（BAV）患者的冠心病（CAD）患病率低于三叶式主动脉瓣（TAV）患者。然而，这一发现受到了挑战。我们进行了一项荟萃分析，以评估主动脉瓣形态是否与 CAD、同时进行的冠状动脉旁路移植术（CABG）和术后死亡率有不同的关联。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行详细搜索，以确定所有接受主动脉瓣手术的 BAV 或 TAV 患者以及 CAD、同时进行的心肌外科血运重建术和术后死亡率的存在。共纳入 31 项研究，涉及 3017 例 BAV 和 4586 例 TAV 患者。BAV 患者 CAD（比值比 [OR]：0.33；95%可信区间：0.17，0.65）、同时 CABG（OR，0.45；95%可信区间：0.35，0.59）和术后死亡率（OR，0.62；95%可信区间：0.40，0.97）的发生率低于 TAV。然而，BAV 患者明显比 TAV 年轻（平均差异：-7.29；95%可信区间：-11.17，-3.41），男性比例更高（OR，1.61；95%可信区间：1.33，1.94），高血压（OR，0.58；95%可信区间：0.39，0.87）和糖尿病（OR，0.71；95%可信区间：0.54，0.93）的发生率较低。有趣的是，荟萃回归分析显示，年龄较小和糖尿病患病率较低与 BAV 患者 CAD（Z 值：-3.03；P=0.002 和 Z 值：-3.10；P=0.002）和 CABG（Z 值：-2.69；P=0.007 和 Z 值：-3.36；P=0.001）的发生率较低有关。
对原始数据的分析表明，主动脉瓣形态与 CAD、同时进行的 CABG 和术后死亡率之间存在关联。有趣的是，年龄和糖尿病的差异对 BAV 和 TAV 之间 CAD 的发生率有深远的影响。总之，我们的荟萃分析表明，CAD 的存在与主动脉瓣形态无关。
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