经导管二尖瓣介入治疗后的脑血管事件：一项系统评价和荟萃分析。

Cerebrovascular events after transcatheter mitral valve interventions: a systematic review and meta-analysis.

作者信息

Châteauneuf Gabriel, Nazif Tamim M, Beaupré Frédéric, Kodali Susheel, Rodés-Cabau Josep, Paradis Jean-Michel

机构信息

Cardiology, Quebec Heart and Lung Institute, Quebec, Quebec, Canada.

Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA.

出版信息

Heart. 2020 Nov;106(22):1759-1768. doi: 10.1136/heartjnl-2019-316331. Epub 2020 Apr 17.

DOI:10.1136/heartjnl-2019-316331

PMID:32303631

Abstract

OBJECTIVE

Current guidelines support the use of transcatheter mitral valve interventions to treat some selected high-risk patients with significant mitral valvulopathy. As with any other interventional cardiac procedure, concerns have been raised about cerebrovascular event. The aim of this systematic review and meta-analysis was to determine the incidence of cerebrovascular events following (1) transcatheter mitral valve edge-to-edge repair with mitral valve clip and (2) transcatheter mitral valve replacement (TMVR).

METHODS

We conducted a systematic review of studies reporting the cerebrovascular adverse events after transcatheter mitral valve edge-to-edge repair and TMVR procedures. The primary endpoint was the incidence of cerebrovascular events as defined by the Mitral Valve Academic Research Consortium. An event that occurred within 30 days or during index hospitalisation was defined as periprocedural; otherwise it was defined as non-periprocedural. This study was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Aggregated study-level data were pooled using a random effect model. The quality of each study was appraised with the Hawker checklist, a method of systematically reviewing research from different paradigms.

RESULTS

Sixty studies totalling 28 155 patients undergoing edge-to-edge repair with mitral valve clip were included in the analysis. Periprocedural stroke and non-periprocedural stroke rates were 0.9% (95% CI 0.6 to 1.1) and 2.4% (95% CI 1.6 to 3.2), respectively. For TMVR procedures, 26 studies including 1910 patients were analysed. The estimated periprocedural stroke incidence was 1% (95% CI 0.5 to 1.8) compared with 7% (95% CI 0.8 to 18.5) for non-periprocedural stroke.

CONCLUSIONS

Transcatheter mitral valve interventions are associated with low rates of cerebrovascular events. The exact mechanisms of these complications are still poorly understood given the relative paucity of good quality data.

TRIAL REGISTRATION NUMBER

CRD42019117257.

摘要

目的

当前指南支持采用经导管二尖瓣介入治疗某些选定的患有严重二尖瓣病变的高危患者。与任何其他心脏介入手术一样，人们对脑血管事件也有所担忧。本系统评价和荟萃分析的目的是确定以下两种情况后脑血管事件的发生率：（1）使用二尖瓣夹进行经导管二尖瓣缘对缘修复；（2）经导管二尖瓣置换术（TMVR）。

方法

我们对报告经导管二尖瓣缘对缘修复和TMVR手术后脑血管不良事件的研究进行了系统评价。主要终点是二尖瓣学术研究联盟定义的脑血管事件发生率。在30天内或索引住院期间发生的事件定义为围手术期事件；否则定义为非围手术期事件。本研究是按照系统评价和荟萃分析的首选报告项目指南设计的。使用随机效应模型汇总研究水平的汇总数据。每项研究的质量使用霍克清单进行评估，这是一种系统评价来自不同范式研究的方法。

结果

分析纳入了60项研究，共28155例接受二尖瓣夹缘对缘修复的患者。围手术期卒中率和非围手术期卒中率分别为0.9%（95%CI 0.6至1.1）和2.4%（95%CI 1.6至3.2）。对于TMVR手术，分析了26项研究，共1910例患者。估计围手术期卒中发生率为1%（95%CI 0.5至1.8），而非围手术期卒中发生率为7%（95%CI 0.8至18.5）。