Meco Massimo, Miceli Antonio, Montisci Andrea, Donatelli Francesco, Cirri Silvia, Ferrarini Matteo, Lio Antonio, Glauber Mattia
Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy.
Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.
Interact Cardiovasc Thorac Surg. 2018 Feb 1;26(2):202-209. doi: 10.1093/icvts/ivx294.
The aim of this meta-analysis was to compare outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) with those undergoing surgical aortic valve replacement using sutureless valves.
A systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed.
No randomized controlled trials were identified. Six comparative studies using propensity score matching met the inclusion criteria. This meta-analysis identified 1462 patients in that 731 patients underwent surgical aortic valve replacement using sutureless valves (SU) and 731 patients underwent a TAVI. The 30-day or in-hospital mortality was lower in the SU group [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.36-0.80; P = 0.003]. In the TAVI group, the incidence of postoperative stroke was higher (OR 0.36, 95% CI 0.17-0.79; P = 0.01). The incidence of moderate or severe paravalvular regurgitation was higher in the TAVI group (OR 0.22, 95% CI 0.14-0.35; P = 0.001). There were neither differences in the postoperative renal failure (OR 1.44, 95% CI 0.46-4.58; P = 0.53) nor in the number of patients requiring postoperative pacemaker implantation (OR 1.06, 95% CI 0.54-2.08; P = 0.86). Patients in the SU group required more transfusions (OR 4.47, 95% CI 2.77-7.21; P = 0.0001), whereas those in the TAVI group had higher major vascular complications (OR 0.06, 95% CI 0.01-0.25; P = 0.0001). Intensive care unit stay was not different (mean difference 0.99, 95% CI - 1.22 to 1.40; P = 0.53). One-year survival was better in the SU group (Peto OR 0.35, 95% CI 0.18-0.67; P = 0.001), as was the 2-year survival (Peto OR 0.38, 95% CI 0.17-0.86; P = 0.001).
Surgical aortic valve replacement using sutureless valves is associated with better early and mid-term outcomes compared with TAVI in high- or intermediate-risk patients.
本荟萃分析旨在比较经导管主动脉瓣植入术（TAVI）患者与接受无缝线瓣膜手术主动脉瓣置换术患者的结局。
按照系统评价和荟萃分析的首选报告项目（PRISMA）声明进行系统评价和荟萃分析。
未检索到随机对照试验。六项采用倾向评分匹配的比较研究符合纳入标准。本荟萃分析纳入了1462例患者，其中731例患者接受了无缝线瓣膜手术主动脉瓣置换术（SU），731例患者接受了TAVI。SU组30天或住院死亡率较低[比值比（OR）0.54，95%置信区间（CI）0.36 - 0.80；P = 0.003]。在TAVI组中，术后中风发生率较高（OR 0.36，95% CI 0.17 - 0.79；P = 0.01）。TAVI组中、重度瓣周反流发生率较高（OR 0.22，95% CI 0.14 - 0.35；P = 0.001）。术后肾衰竭方面无差异（OR 1.44，95% CI 0.46 - 4.58；P = 0.53），术后需要植入起搏器的患者数量也无差异（OR 1.06，95% CI 0.54 - 2.08；P = 0.86）。SU组患者需要更多输血（OR 4.47，95% CI 2.77 - 7.21；P = 0.0001），而TAVI组主要血管并发症发生率较高（OR 0.06，95% CI 0.01 - 0.25；P = 0.0001）。重症监护病房住院时间无差异（平均差0.99，95% CI - 1.22至1.40；P = 0.53）。SU组1年生存率更高（Peto OR 0.35，95% CI 0.18 - 0.67；P = 0.001），2年生存率也是如此（Peto OR 0.38，95% CI 0.17 - 0.86；P = 0.001）。
对于高风险或中风险患者，与TAVI相比，使用无缝线瓣膜进行手术主动脉瓣置换术具有更好的早期和中期结局。
