低流量/低梯度主动脉瓣狭窄对经导管主动脉瓣植入术后生存影响的荟萃分析。
A meta-analysis of impact of low-flow/low-gradient aortic stenosis on survival after transcatheter aortic valve implantation.
机构信息
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka.
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
出版信息
J Cardiovasc Med (Hagerstown). 2019 Oct;20(10):691-698. doi: 10.2459/JCM.0000000000000836.
AIMS
To determine whether low-flow/low-gradient (LF/LG) aortic stenosis affects survival after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of currently available studies.
METHODS
MEDLINE and EMBASE were searched through January 2019 using PubMed and OVID. Observational studies comparing all-cause mortality after TAVI for patients with classical LF/LG (C/LF/LG) aortic stenosis versus normal-flow/high-gradient (NF/HG) aortic stenosis, paradoxical LF/LG (P/LF/LG) aortic stenosis versus NF/HG aortic stenosis, and (3) C/LF/LG aortic stenosis versus P/LF/LG aortic stenosis were included. Study-specific estimates, risk and hazard ratios of mortality, were combined in the random-effects model.
RESULTS
Our search identified nine eligible studies including a total of 5512 TAVI patients. Pooled analysis demonstrated significantly higher early mortality in C/LF/LG aortic stenosis than NF/HG aortic stenosis (risk ratio, 1.72; P = 0.02) and no statistically significant difference in early mortality between P/LF/LG aortic stenosis and NF/HG aortic stenosis (P = 0.67) and between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis (P = 0.51). Midterm mortality in C/LF/LG (risk ratio/hazard ratio, 1.73; P = 0.0003) and P/LF/LG aortic stenosis (risk ratio/hazard ratio, 1.48; P < 0.0001) was significantly higher than that in NF/HG aortic stenosis. There was no statistically significant difference in midterm mortality between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis (P = 0.63).
CONCLUSION
After TAVI, C/LF/LG aortic stenosis is associated with increased early mortality compared with NF/HG, and C/LF/LG and P/LF/LG aortic stenosis is associated with increased midterm mortality compared with NF/HG aortic stenosis despite no difference in early mortality between P/LF/LG aortic stenosis and NF/HG aortic stenosis. There is no difference in early and midterm mortality between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis.
目的
通过荟萃分析目前已有的研究，确定低流量/低梯度（LF/LG）主动脉瓣狭窄是否会影响经导管主动脉瓣植入（TAVI）后的生存率。
方法
通过使用 PubMed 和 OVID 检索 MEDLINE 和 EMBASE，检索时间截至 2019 年 1 月。纳入比较经典 LF/LG（C/LF/LG）主动脉瓣狭窄与正常流量/高梯度（NF/HG）主动脉瓣狭窄、反常 LF/LG（P/LF/LG）主动脉瓣狭窄与 NF/HG 主动脉瓣狭窄以及（3）C/LF/LG 主动脉瓣狭窄与 P/LF/LG 主动脉瓣狭窄患者 TAVI 后全因死亡率的观察性研究。采用随机效应模型对研究特异性死亡率风险比和危险比进行合并。
结果
我们的检索共确定了 9 项符合条件的研究，共纳入了 5512 例 TAVI 患者。汇总分析显示，C/LF/LG 主动脉瓣狭窄患者的早期死亡率明显高于 NF/HG 主动脉瓣狭窄患者（风险比，1.72；P=0.02），而 P/LF/LG 主动脉瓣狭窄患者与 NF/HG 主动脉瓣狭窄患者（P=0.67）以及 C/LF/LG 主动脉瓣狭窄患者与 P/LF/LG 主动脉瓣狭窄患者（P=0.51）之间的早期死亡率无统计学差异。C/LF/LG（风险比/危险比，1.73；P=0.0003）和 P/LF/LG 主动脉瓣狭窄（风险比/危险比，1.48；P<0.0001）患者的中期死亡率明显高于 NF/HG 主动脉瓣狭窄患者。C/LF/LG 主动脉瓣狭窄患者与 P/LF/LG 主动脉瓣狭窄患者之间的中期死亡率无统计学差异（P=0.63）。
结论
与 NF/HG 相比，TAVI 后 C/LF/LG 主动脉瓣狭窄患者的早期死亡率更高，而 C/LF/LG 和 P/LF/LG 主动脉瓣狭窄患者的中期死亡率更高，尽管 P/LF/LG 主动脉瓣狭窄患者与 NF/HG 主动脉瓣狭窄患者的早期死亡率无差异。C/LF/LG 主动脉瓣狭窄患者与 P/LF/LG 主动脉瓣狭窄患者的早期和中期死亡率无差异。
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