Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Scand Cardiovasc J. 2021 Jun;55(3):168-172. doi: 10.1080/14017431.2020.1866210. Epub 2020 Dec 26.
Although a number of studies compared mortality after transcatheter aortic valve implantation (TAVI) with that after surgical aortic replacement (SAVR) in patients with chronic obstructive pulmonary disease (COPD), no meta-analysis of them has been conducted to date. To determine whether TAVI or SAVR is associated with better postprocedural survival in patients with COPD, a meta-analysis of all studies currently available was performed. To identify all comparative studies of TAVI with SAVR in patients with COPD, PubMed and Web of Science were searched through January 2020. Studies meeting the following criteria were included in the present meta-analysis: the design was an observational comparative study or a randomized controlled trial; the study population was patients with COPD; patients were assigned to TAVI versus SAVR; and outcomes included all-cause mortality. Adjusted (if unavailable, unadjusted) odds or hazard ratios with their confidence intervals (CIs) of mortality for TAVI versus SAVR were extracted from each study. Study-specific estimates were combined in the random-effects model. Six eligible studies with a total of 4771 patients with COPD were identified and included in the present meta-analysis. The meta-analysis indicated significantly lower early (in-hospital or 30-day) mortality after TAVI than after SAVR (odds ratio, 0.69; 95% CI, 0.53-0.90; = .006) but no significant difference in midterm (1-year to 5-year) mortality between TAVI and SAVR (hazard ratio, 1.07; 95% CI, 0.79-1.44; = .68). In patients with COPD, TAVI was associated with reduced early mortality, while midterm mortality appeared similar, as compared with SAVR.
尽管已经有一些研究比较了慢性阻塞性肺疾病（COPD）患者行经导管主动脉瓣置换术（TAVI）与外科主动脉瓣置换术（SAVR）的死亡率，但迄今为止，尚未对这些研究进行荟萃分析。为了确定 TAVI 或 SAVR 是否与 COPD 患者术后生存更好相关，对目前所有可用的研究进行了荟萃分析。为了确定所有关于 COPD 患者 TAVI 与 SAVR 的比较研究，通过 2020 年 1 月前的 PubMed 和 Web of Science 进行了搜索。本荟萃分析纳入了以下标准的观察性比较研究或随机对照试验：设计为观察性比较研究或随机对照试验；研究人群为 COPD 患者；患者被分配到 TAVI 与 SAVR 组；结局包括全因死亡率。从每项研究中提取 TAVI 与 SAVR 死亡率的调整（如果不可用，则为未调整）比值比或风险比及其置信区间（CI）。研究特异性估计值在随机效应模型中合并。
确定了六项符合条件的研究，共有 4771 例 COPD 患者，纳入本荟萃分析。荟萃分析表明，TAVI 的早期（住院或 30 天）死亡率明显低于 SAVR（比值比，0.69；95%CI，0.53-0.90；P =.006），但 TAVI 与 SAVR 的中期（1 年至 5 年）死亡率无显著差异（风险比，1.07；95%CI，0.79-1.44；P =.68）。在 COPD 患者中，与 SAVR 相比，TAVI 降低了早期死亡率，而中期死亡率似乎相似。
