Yanagawa Bobby, Tam Derrick Y, Hong Kathryn, Mazine Amine, Bagai Akshay, Shahbaz Nazgol Kafaei, Ouzounian Maral, Verma Subodh
From the Divisions of Cardiac Surgery and.
Cardiology, St Michael's Hospital, University of Toronto, Toronto, ON Canada.
Innovations (Phila). 2018 Jul/Aug;13(4):267-272. doi: 10.1097/IMI.0000000000000534.
This meta-analysis compares the early echocardiographic outcomes of aortic valve replacement using the two most commonly implanted stented bioprostheses.
We searched MEDLINE and EMBASE databases until 2017 for studies comparing Magna or Magna Ease (Edwards Lifesciences, Irvine, CA USA) versus Trifecta (St Jude Medical, St. Paul, MN USA) aortic bioprosthetic valves. A random-effects meta-analysis was performed for the primary outcome of mean gradient on echocardiography and secondary outcomes of effective orifice area, indexed effective orifice area, and in-hospital mortality.
There were two randomized controlled trial, three matched, and six unmatched retrospective observational studies with 2119 patients [median reported follow-up = 6 months (interquartile range = 6 to 12)]. The Magna/Magna Ease valve was associated with higher early mean gradient (mean difference = 4.09, 95% confidence interval = 3.48 to 4.69, P < 0.0001) and smaller effective orifice area (mean difference = 0.30, 95% confidence interval = -0.38 to -0.22, P < 0.0001). There were no differences in 30-day mortality between Magna/Magna Ease and Trifecta (relative risk = 1.01, 95% confidence interval = 0.41 to 2.50, P = 1.0).
Trifecta may offer a small hemodynamic advantage compared with the Magna/Magna Ease valve with no differences in early mortality. Long-term follow-up is required to determine whether these differences persist and translate into differences in clinical outcomes.
本荟萃分析比较了使用两种最常用的置入式带支架生物瓣膜进行主动脉瓣置换术后的早期超声心动图结果。
我们检索了MEDLINE和EMBASE数据库至2017年的研究，比较麦格纳或麦格纳易安（爱德华生命科学公司，美国加利福尼亚州尔湾）与三连胜（圣犹达医疗公司，美国明尼苏达州圣保罗）主动脉生物瓣膜。对超声心动图平均梯度的主要结局以及有效瓣口面积、指数化有效瓣口面积和住院死亡率的次要结局进行随机效应荟萃分析。
有两项随机对照试验、三项匹配和六项不匹配的回顾性观察性研究，共2119例患者[中位报告随访时间 = 6个月（四分位间距 = 6至12个月）]。麦格纳/麦格纳易安瓣膜与更高的早期平均梯度相关（平均差异 = 4.09，95%置信区间 = 3.48至4.69，P < 0.0001）且有效瓣口面积更小（平均差异 = 0.30，95%置信区间 = -0.38至 -0.22，P < 0.0001）。麦格纳/麦格纳易安与三连胜在30天死亡率上无差异（相对风险 = 1.01，95%置信区间 = 0.41至2.50，P = 1.0）。
与麦格纳/麦格纳易安瓣膜相比，三连胜可能具有较小的血流动力学优势，早期死亡率无差异。需要长期随访以确定这些差异是否持续并转化为临床结局的差异。
