Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Catheter Cardiovasc Interv. 2019 Apr 1;93(5):946-953. doi: 10.1002/ccd.27948. Epub 2018 Nov 25.
To determine whether concomitant tricuspid regurgitation (TR) is associated with increased mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic-valve implantation (TAVI), we performed a meta-analysis of currently available studies.
MEDLINE and EMBASE were searched through May 2018. We included comparative or cohort studies enrolling patients with AS undergoing TAVI and reporting early (in-hospital or 30-day) and late (including early) all-cause mortality in patients stratified by baseline TR grade. An odds ratio (OR) of early mortality and a hazard ratio (HR) of late mortality with its 95% CI for significant versus non-significant (typically, ≥moderate versus <moderate) TR was extracted. Study-specific estimates were combined in the random-effects model.
Our search identified 12 eligible studies enrolling a total of 41,485 TAVI patients. The meta-analysis for early mortality combining 3 ORs demonstrated a significant 1.80-fold increase in mortality with significant TR (OR, 1.80; 95% CI, 1.01 to 3.19; P = 0.05). The primary meta-analysis for midterm (6-month to 30-month) mortality combining all the 12 HRs/ORs indicated a significant 1.96-fold increase in mortality (HR/OR, 1.96; 95% CI, 1.35 to 2.85; P = 0.0004). The secondary meta-analysis for midterm mortality combining 7 homogeneous HRs (adjusted HRs for ≥moderate versus <moderate TR) showed a significant 2.25-fold increase in mortality (HR, 2.25; 95% CI, 1.20-4.24; P = 0.01).
Concurrent significant (typically, ≥moderate) TR is associated with an approximately two-fold increase in both early and midterm all-cause mortality in patients with AS undergoing TAVI.
通过荟萃分析目前可用的研究，确定在接受经导管主动脉瓣置换术（TAVI）治疗的严重主动脉瓣狭窄（AS）患者中，同时存在三尖瓣反流（TR）是否与死亡率增加相关。
检索 MEDLINE 和 EMBASE，检索时间截至 2018 年 5 月。纳入了比较或队列研究，这些研究纳入了接受 TAVI 治疗的 AS 患者，并报告了根据基线 TR 分级分层的患者的早期（住院期间或 30 天）和晚期（包括早期）全因死亡率。提取早期死亡率的优势比（OR）和晚期死亡率的风险比（HR）及其 95%置信区间（CI），用于比较显著与非显著（通常为≥中度与<中度）TR。使用随机效应模型对研究特异性估计值进行合并。
我们的检索共确定了 12 项符合条件的研究，共纳入了 41485 例 TAVI 患者。合并 3 个 OR 的早期死亡率荟萃分析显示，严重 TR 患者的死亡率显著增加 1.80 倍（OR，1.80；95%CI，1.01 至 3.19；P=0.05）。合并所有 12 个 HR/OR 的中期（6 个月至 30 个月）死亡率的主要荟萃分析表明，死亡率显著增加 1.96 倍（HR/OR，1.96；95%CI，1.35 至 2.85；P=0.0004）。合并 7 个同质 HR（调整 TR 为≥中度与<中度的 HR）的中期死亡率的次要荟萃分析显示，死亡率显著增加 2.25 倍（HR，2.25；95%CI，1.20 至 4.24；P=0.01）。
在接受 TAVI 治疗的 AS 患者中，同时存在严重（通常为≥中度）TR 与早期和中期全因死亡率增加约 2 倍相关。
