Cao Yunshan, Singh Vikas, Wang Aqian, Zhang Liyan, He Tingting, Su Hongling, Wei Rong, Duan Yichao, Jiang Kaiyu, Wu Wenyu, Huang Yan, Elmariah Sammy, Qi Guanming, Su Xin, Zhang Yan, Zhang Min
Department of Cardiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Chengguan District, Lanzhou, Gansu 730000, China.
Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Ther Adv Chronic Dis. 2020 Jul 3;11:2040622320933775. doi: 10.1177/2040622320933775. eCollection 2020.
Right ventricular function (RVF) is an independent predictor of prognosis for patients undergoing aortic valve replacement: transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). The effect of transfemoral aortic valve replacement (TF-TAVR) on RVF is uncertain. We aimed to perform a meta-analysis of the effect of TF-TAVR on RVF in patients with aortic stenosis (AS) and compare the effect of TF-TAVR with SAVR.
We searched relevant studies from PubMed, Embase, Cochrane Library databases, and Web of Science. Furthermore, two reviewers (Wang AQ and Cao YS) extracted all relevant data, which were then double checked by another two reviewers (Zhang M and Qi GM). We used the forest plot to present results. Tricuspid annular plane systolic excursion (TAPSE) was the primary outcome.
This meta-analysis included 11 studies. There were 353 patients who underwent TF-TAVR, and 358 patients who were subjected to SAVR. There was no significant difference in TAPSE at 1 week and 6 months as well as right ventricular ejection fraction (RVEF) at <2 weeks and 6 months after TF-TAVR. For the SAVR group, TAPSE at 1 week and 3 months as well as fractional area change (FAC) at 3 months post procedure were significantly aggravated, while RVEF did not change significantly. Moreover, TAPSE post-TF-TAVR was significantly improved as compared with post-SAVR. The △TAPSE, the difference between TAPSE post-procedure and TAPSE prior to procedure, was also significantly better in the TF-TAVR group than in the SAVR group.
RVF was maintained post TF-TAVR. For SAVR, discrepancy in the measured parameters exists, as reduced TAPSE indicates compromised longitudinal RVF, while insignificant changes in RVEF implicate maintained RVF post procedure. Collectively, our study suggests that the baseline RV dysfunction and the effect of TF-TAVR SAVR on longitudinal RVF may influence the selection of aortic valve intervention.
右心室功能（RVF）是接受主动脉瓣置换术患者预后的独立预测指标：经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）。经股动脉主动脉瓣置换术（TF-TAVR）对RVF的影响尚不确定。我们旨在对TF-TAVR对主动脉瓣狭窄（AS）患者RVF的影响进行荟萃分析，并比较TF-TAVR与SAVR的效果。
我们在PubMed、Embase、Cochrane图书馆数据库和Web of Science中检索相关研究。此外，两位审阅者（王AQ和曹YS）提取了所有相关数据，然后由另外两位审阅者（张M和齐GM）进行复查。我们使用森林图展示结果。三尖瓣环平面收缩期位移（TAPSE）是主要结局指标。
这项荟萃分析纳入了11项研究。353例患者接受了TF-TAVR，358例患者接受了SAVR。TF-TAVR术后1周和6个月时的TAPSE以及术后<2周和6个月时的右心室射血分数（RVEF）无显著差异。对于SAVR组，术后1周和3个月时的TAPSE以及术后3个月时的面积变化分数（FAC）显著恶化，而RVEF无显著变化。此外，与SAVR术后相比，TF-TAVR术后的TAPSE显著改善。TF-TAVR组术后TAPSE与术前TAPSE的差值△TAPSE也显著优于SAVR组。
TF-TAVR术后RVF得以维持。对于SAVR，测量参数存在差异，TAPSE降低表明右心室纵向功能受损，而RVEF无显著变化表明术后RVF得以维持。总体而言，我们的研究表明基线右心室功能障碍以及TF-TAVR与SAVR对右心室纵向功能的影响可能会影响主动脉瓣干预方式的选择。
