Neupane Saroj, Singh Hemindermeet, Lämmer Johannes, Othman Hussein, Yamasaki Hiroshi, Rosman Howard S, Bossone Eduardo, Mehta Rajendra H, Eggebrecht Holger
Division of Cardiology, Department of Internal Medicine, St John Hospital and Medical Center, Detroit, Michigan.
Division of Cardiology, Mercy-Health St Vincent Medical Center, Toledo, Ohio.
Am J Cardiol. 2018 Jun 15;121(12):1593-1600. doi: 10.1016/j.amjcard.2018.02.054. Epub 2018 Apr 19.
Transcatheter valve-in-valve implantation (ViV-TAVI) has evolved as an alternative to redo surgical valve replacement (redo-SAVR) for high-risk patients with aortic bioprosthetic valve (BPV) dysfunction. The differences in procedural success and outcomes in a large number of patients who underwent ViV-TAVI compared with redo-SAVR for aortic BPV dysfunction are not known. We conducted a meta-analysis of the previously reported studies to determine outcomes after ViV-TAVI and redo-SAVR. PubMed, MEDLINE, and Google Scholar databases were searched for studies that reported comparative outcomes of patients who underwent either ViV-TAVI or redo-SAVR. Four observational studies met the inclusion criteria, with a total of 489 patients, 227 of whom underwent ViV-TAVI and 262 underwent redo-SAVR. Thirty-day mortality was similar in 2 groups (5% vs 4%; odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.44 to 2.62) despite the higher operative risk in the ViV-TAVI cohort as evidenced by significantly higher EuroSCORE I or II. There were similar rates of stroke (2% vs 2%; OR = 1.00, 95% CI = 0.28 to 3.59), myocardial infarction (2% vs 1%; OR = 1.08, 95% CI = 0.27 to 4.33), and acute kidney injury requiring dialysis (7% vs 10%; OR = 0.80, 95% CI = 0.36 to 0.1.77) between 2 groups but a lower rate of permanent pacemaker implantation in the ViV-TAVI group (9% vs 15%; OR = 0.44, 95% CI = 0.24 to 0.81). This meta-analysis of nonrandomized studies with modest number of patients suggested that ViV-TAVI had similar 30-day survival compared with redo-SAVR for aortic BPV dysfunction.
经导管瓣中瓣植入术（ViV-TAVI）已发展成为主动脉生物瓣（BPV）功能障碍的高危患者再次行外科瓣膜置换术（redo-SAVR）的替代方案。与redo-SAVR相比，大量接受ViV-TAVI的患者在手术成功率和结局方面的差异尚不清楚。我们对先前报道的研究进行了荟萃分析，以确定ViV-TAVI和redo-SAVR后的结局。在PubMed、MEDLINE和谷歌学术数据库中搜索了报告接受ViV-TAVI或redo-SAVR患者比较结局的研究。四项观察性研究符合纳入标准，共有489例患者，其中227例接受了ViV-TAVI，262例接受了redo-SAVR。尽管ViV-TAVI队列的手术风险较高，欧洲心脏手术风险评估系统（EuroSCORE）I或II显著更高，但两组的30天死亡率相似（5%对4%；优势比[OR]=1.08，95%置信区间[CI]=0.44至2.62）。两组之间的中风发生率（2%对2%；OR=1.00，95%CI=0.28至3.59）、心肌梗死发生率（2%对1%；OR=1.08，95%CI=0.27至4.33）以及需要透析的急性肾损伤发生率（7%对10%；OR=0.80，95%CI=0.36至1.77）相似，但ViV-TAVI组的永久起搏器植入率较低（9%对15%；OR=0.44，95%CI=0.24至0.81）。这项对患者数量有限的非随机研究的荟萃分析表明，对于主动脉BPV功能障碍，ViV-TAVI与redo-SAVR的30天生存率相似。
