Salcher Maximilian, Naci Huseyin, Pender Sarah, Kuehne Titus, Kelm Marcus
Department of Social Policy, LSE Health , London School of Economics and Political Science , London , UK.
Department of Social Policy, LSE Health, London School of Economics and Political Science, London, UK; London School of Hygiene and Tropical Medicine, London, UK.
Open Heart. 2016 Dec 16;3(2):e000502. doi: 10.1136/openhrt-2016-000502. eCollection 2016.
Aortic valve repair is still emerging, and its role in the treatment of bicuspid aortic valve disease (BAVD) is not yet fully understood. Our objective is to synthesise available evidence on outcomes after surgical aortic valve repair in patients with BAVD. We conducted a systematic review of clinical studies using prespecified methods for searching, identifying and selecting eligible studies in 4 databases, and synthesising results (PROSPERO 2014:CRD42014014415). 2 researchers independently reviewed full-text articles and extracted data. The results of included studies were quantitatively synthesised in frequentist meta-analyses. We included 11 aortic valve repair studies or study arms with a total of 2010 participants. Pooled estimates for the proportion of patients surviving at 30 days, 1 year, 5 years and 10 years were 0.995 (95% CI 0.991 to 0.995), 0.994 (0.989 to 0.999), 0.945 (0.898 to 0.993) and 0.912 (0.845 to 0.979), respectively. The pooled proportion of late deaths from valve-related causes was 0.008 (0.000 to 0.019) at a mean follow-up of 3.5 years. Proportion of patients with valve-related reinterventions was 0.075 (0.037 to 0.113) at a mean follow-up of 3.9 years, and the linearised reintervention rate was 1.3 (0.7 to 1.9) per 100 patient-years. Outcome reporting was insufficient to pool the results for a number of predefined outcomes. In conclusion, existing evidence on aortic valve repair in BAVD is limited to mostly small case series, case-control and small retrospective cohort studies. Despite the low quality, available evidence suggests favourable survival outcomes after aortic valve repair in selected patients with BAVD. Valve-related reinterventions at follow-up are common in all patients undergoing repair surgery.
主动脉瓣修复仍在不断发展，其在治疗二叶式主动脉瓣疾病（BAVD）中的作用尚未完全明确。我们的目标是综合现有关于BAVD患者接受外科主动脉瓣修复术后结局的证据。我们采用预先设定的方法在4个数据库中检索、识别和选择符合条件的临床研究，并对结果进行综合分析（PROSPERO 2014：CRD42014014415）。两名研究人员独立审查全文并提取数据。纳入研究的结果在频率论元分析中进行定量综合。我们纳入了11项主动脉瓣修复研究或研究组，共有2010名参与者。30天、1年、5年和10年存活患者比例的合并估计值分别为0.995（95%CI 0.991至0.995）、0.994（0.989至0.999）、0.945（0.898至0.993）和0.912（0.845至0.979）。在平均3.5年的随访中，瓣膜相关原因导致的晚期死亡合并比例为0.008（0.000至0.019）。在平均3.9年的随访中，瓣膜相关再次干预患者的比例为0.075（0.037至0.113），线性化再次干预率为每100患者年1.3（0.7至1.9）。对于一些预定义结局，结局报告不足以汇总结果。总之，现有关于BAVD主动脉瓣修复的证据大多限于小型病例系列、病例对照和小型回顾性队列研究。尽管质量较低，但现有证据表明，部分选定的BAVD患者接受主动脉瓣修复术后的生存结局良好。在所有接受修复手术的患者中，随访时瓣膜相关再次干预很常见。
