Zhou Ying, Xiong Tixiusi, Bai Peng, Chu Chong, Dong Nianguo
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
J Thorac Dis. 2019 Dec;11(12):5343-5351. doi: 10.21037/jtd.2019.11.64.
Transcatheter pulmonary valve replacement (TPVR) has currently been a well-established alternative operation method to surgical pulmonary valve replacement (SPVR) in patients with pulmonary valve dysfunction in the form of stenosis and/or regurgitation. We conducted a meta-analysis to evaluate the main clinical outcomes after TPVR and SPVR.
We systematically searched the references of relevant literatures from PubMed and the Cochrane Library published between January 2000 and December 2018 and followed The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) for this study.
Eleven studies with 4,364 patients were included in the study. Compared with SPVR, TPVR results in a significant decreased in-hospital mortality [odds ratio (OR): 0.18; 95% confidence interval (CI): 0.03-0.98] and mortality at the longest reported follow-up time point (OR: 0.43; 95% CI: 0.22-0.87), though 30-day mortality (OR: 0.38; 95% CI: 0.11-1.33) has no significant difference between groups. Days of hospital stay [(mean difference (MD): -4.38; 95% CI: -6.24--2.53] is shorter with TPVR than SPVR. Besides, rates of 30-day readmission (OR: 0.67; 95% CI: 0.50-0.91) and recurrent pulmonary regurgitation (OR: 0.17; 95% CI: 0.07-0.42) are lower with TPVR, whereas postprocedural infective endocarditis (IE) (OR: 4.56; 95% CI: 2.03-10.26) are higher with TPVR. SPVR carries a decreased risk of re-operation (OR: 2.19; 95% CI: 0.62-7.76) though without statistically significance.
In conclusion, TPVR is associated with a significantly decreased mortality, a shorter length of hospital-stay, a lower rate of 30-day readmission and recurrent pulmonary regurgitation as compared to SPVR throughout the follow-up duration, whereas SPVR results in a significantly lower rate of postprocedural IE than TPVR. In addition, SPVR carries a decreased risk of re-operation with statistically insignificance.
经导管肺动脉瓣置换术（TPVR）目前已成为一种成熟的替代手术方法，用于治疗存在狭窄和/或反流形式的肺动脉瓣功能障碍患者的外科肺动脉瓣置换术（SPVR）。我们进行了一项荟萃分析，以评估TPVR和SPVR后的主要临床结局。
我们系统检索了2000年1月至2018年12月期间在PubMed和Cochrane图书馆发表的相关文献的参考文献，并遵循本研究的系统评价和荟萃分析的首选报告项目（PRISMA）。
该研究纳入了11项研究，共4364例患者。与SPVR相比，TPVR导致住院死亡率显著降低[比值比（OR）：0.18；95%置信区间（CI）：0.03 - 0.98]以及在最长报告随访时间点的死亡率降低（OR：0.43；95% CI：0.22 - 0.87），尽管两组之间30天死亡率（OR：0.38；95% CI：0.11 - 1.33）无显著差异。TPVR的住院天数[平均差（MD）：-4.38；95% CI：-6.24 - -2.53]比SPVR短。此外，TPVR的30天再入院率（OR：0.67；95% CI：0.50 - 0.91）和复发性肺动脉反流率（OR：0.17；95% CI：0.07 - 0.42）较低，而TPVR术后感染性心内膜炎（IE）的发生率（OR：4.56；95% CI：2.03 - 10.26）较高。SPVR再次手术风险降低（OR：2.19；95% CI：0.62 - 7.76），但无统计学意义。
总之，与SPVR相比，在整个随访期间，TPVR与显著降低的死亡率、更短的住院时间、更低的30天再入院率和复发性肺动脉反流率相关，而SPVR导致术后IE发生率显著低于TPVR。此外，SPVR再次手术风险降低，但无统计学意义。
