Department of Medicine Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group.
Department of Medicine Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan.
Am J Cardiol. 2019 Mar 1;123(5):827-832. doi: 10.1016/j.amjcard.2018.11.031. Epub 2018 Dec 3.
Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is a rare but life-threatening complication. Paravalvular regurgitation, compression of native leaflets, and space between transcatheter valve prosthesis and native valves could dispose TAVI recipients at increased risk of IE compared with SAVR. To assess the comparative risk of IE between TAVI and SAVR, we performed a systematic review and meta-analysis. A literature search of PUBMED and EMBASE was performed to identify randomized controlled trials that reported the event rate of IE in both TAVI and SAVR. A Mantel-Haenszel method and a random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). The studied outcomes were early (at 1-year), late (>1-year), and overall IE (postprocedure to longest follow-up) in TAVI versus SAVR. We performed subgroup analysis based on valve-type (self or balloon-expandable) and surgical risk (high or intermediate). A total of 4 studies with 3,761 (1,895 TAVI and 1,866 SAVR) patients were included. The incidence of early IE, (3 studies, 0.86% vs 0.73%, OR 1.17, 95% CI 0.51 to 2.65, p = 0.71, I = 0%), late IE (mean follow-up 2.0 years) (3 studies, 1.3% vs 0.6%, OR 1.85, 95% CI 0.81 to 4.20, p = 0.42, I = 0%), and overall IE (mean follow-up 3.4 years) (4 studies, 2.0% vs 1.3%, OR 1.44, 95% CI 0.85 to 2.43, p = 0.18, I = 0%) was similar between TAVI and SAVR. Subgroup analysis suggested that in intermediate surgical risk cohort, there was a trend toward increased risk of overall IE in TAVI (2.3% in TAVI and 1.2% in SAVR, OR 1.92, 95% CI 0.99 to 3.72, p = 0.05 I = 0%). In this meta-analysis, we did not find an increased risk of IE in TAVI compared with SAVR. Appropriate preventative measure and early recognition of IE in these cohorts are important.
经导管主动脉瓣植入术（TAVI）和外科主动脉瓣置换术（SAVR）后感染性心内膜炎（IE）是一种罕见但危及生命的并发症。与 SAVR 相比，瓣周反流、原生瓣叶受压以及经导管瓣假体与原生瓣之间的空间可能使 TAVI 受者发生 IE 的风险增加。为了评估 TAVI 和 SAVR 之间 IE 的比较风险，我们进行了系统评价和荟萃分析。对 PUBMED 和 EMBASE 进行文献检索，以确定报告 TAVI 和 SAVR 中 IE 发生率的随机对照试验。采用 Mantel-Haenszel 法和随机效应模型计算比值比（OR）和 95%置信区间（CI）。研究结果为 TAVI 与 SAVR 相比的早期（1 年）、晚期（>1 年）和总体 IE（术后至最长随访）。我们根据瓣膜类型（自膨式或球囊扩张式）和手术风险（高或中）进行了亚组分析。共纳入 4 项研究，共 3761 例患者（1895 例 TAVI 和 1866 例 SAVR）。早期 IE 的发生率（3 项研究，0.86%比 0.73%，OR 1.17，95%CI 0.51 至 2.65，p=0.71，I=0%）、晚期 IE（平均随访 2.0 年）（3 项研究，1.3%比 0.6%，OR 1.85，95%CI 0.81 至 4.20，p=0.42，I=0%）和总体 IE（平均随访 3.4 年）（4 项研究，2.0%比 1.3%，OR 1.44，95%CI 0.85 至 2.43，p=0.18，I=0%）在 TAVI 和 SAVR 之间相似。亚组分析表明，在中手术风险队列中，TAVI 总体 IE 的风险有增加趋势（TAVI 为 2.3%，SAVR 为 1.2%，OR 1.92，95%CI 0.99 至 3.72，p=0.05，I=0%）。在这项荟萃分析中，我们没有发现 TAVI 比 SAVR 发生 IE 的风险增加。在这些队列中，适当的预防措施和早期识别 IE 非常重要。
