Micali Linda R, Algargoosh Salma, Parise Orlando, Parise Gianmarco, Matteucci Francesco, de Jong Monique, Moula Amalia Ioanna, Tetta Cecilia, Gelsomino Sandro
Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Maastricht, The Netherlands.
J Card Surg. 2021 Mar;36(3):1030-1039. doi: 10.1111/jocs.15209. Epub 2020 Dec 18.
Classical and paradoxical low-flow, low-gradient (LFLG) aortic stenosis (AS) are the most challenging subtypes of AS. The current therapeutic options are aortic valve replacement (AVR) and conservative management: AVR promotes long-term survival but is invasive, while conservative management yields a poor prognosis but is noninvasive since it uses no aortic valve replacement (noAVR). The present meta-analysis investigated the rate of survival of patients with LFLG AS undergoing either AVR or noAVR interventions.
The meta-analysis compared the outcomes of AVR with those of noAVR in terms of patient survival. In both groups, a meta-regression was conducted to investigate the impact on patient survival of the left ventricular ejection fraction (LVEF), either preserved (paradoxical LFLG AS) or reduced (classical LFLG AS).
The relative risk of survival between the AVR and noAVR groups was 1.99 [1.40, 2.82] (p = .0001), suggesting that survival tends to be better in AVR patients than in noAVR patients. The meta-regression revealed that a reduced LVEF may be related to a higher survival in AVR patients when compared to a preserved LVEF (p = .04). Finally, the analysis indicated that LVEF seems not to be prognostic of survival in noAVR patients (p = .18).
Patients with LFLG AS have better survival if they undergo AVR. In AVR patients, reduced LVEF rather than preserved LVEF is related to better survival, whereas there seems to be no difference in prognostic value between reduced and preserved LVEF in noAVR patients.
典型及矛盾性低流量、低跨瓣压差（LFLG）主动脉瓣狭窄（AS）是AS最具挑战性的亚型。目前的治疗选择是主动脉瓣置换术（AVR）和保守治疗：AVR可提高长期生存率，但具有侵入性；而保守治疗预后较差，但为非侵入性，因为不进行主动脉瓣置换（无AVR）。本荟萃分析研究了接受AVR或无AVR干预的LFLG AS患者的生存率。
该荟萃分析比较了AVR与无AVR在患者生存方面的结果。在两组中，均进行了荟萃回归分析，以研究左心室射血分数（LVEF），即保留（矛盾性LFLG AS）或降低（典型LFLG AS）对患者生存的影响。
AVR组与无AVR组的生存相对风险为1.99 [1.40, 2.82]（p = 0.0001），表明AVR患者的生存率往往高于无AVR患者。荟萃回归分析显示，与保留的LVEF相比，LVEF降低可能与AVR患者较高的生存率相关（p = 0.04）。最后，分析表明LVEF似乎对无AVR患者的生存无预后价值（p = 0.18）。
LFLG AS患者接受AVR后生存率更高。在AVR患者中，LVEF降低而非保留与更好的生存率相关，而在无AVR患者中，LVEF降低和保留在预后价值上似乎没有差异。
