Saleem Sameer, Ullah Waqas, Syed Mubbasher Ameer, Megaly Michael, Thalambedu Nishanth, Younas Sundas, Zahid Salman, Alam Mahboob, Virani Salim S, Verma Divya Ratan, Abdul-Waheed Mohammad, Fischman David L
Cardiovascular Medicine, University of Kentucky, Bowling Green, Kentucky, USA.
Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.
Catheter Cardiovasc Interv. 2021 Nov 1;98(5):940-947. doi: 10.1002/ccd.29789. Epub 2021 Jun 10.
The comparative efficacy and safety of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) and redo-surgical AVR (redo-SAVR) in patients with degenerated bioprosthetic aortic valves remain unknown.
Digital databases were searched to identify relevant articles. Unadjusted odds ratios for dichotomous outcomes were calculated using a random effect model. A total of 11 studies comprising 8326 patients (ViV-TAVR = 4083 and redo-SAVR = 4243) were included.
The mean age of patients undergoing ViV-TAVR was older, 76 years compared to 73 years for those undergoing SAVR. The baseline characteristics for patients in ViV-TAVR vs. redo-SAVR groups were comparable. At 30-days, the odds of all-cause mortality (OR 0.45, 95% CI 0.30-0.68, p = .0002), cardiovascular mortality (OR 0.44, 95% CI 0.26-0.73, p = .001) and major bleeding (OR 0.29, 95% CI 0.15-0.54, p = .0001) were significantly lower in patients undergoing ViV-TAVR compared to redo-SAVR. There were no significant differences in the odds of cerebrovascular accidents (OR 0.91, 95% CI 0.52-1.58, p = .74), myocardial infarction (OR 0.92, 95% CI 0.44-1.92, p = .83) and permanent pacemaker implantation (PPM) (OR 0.54, 95% CI 0.27-1.07, p = .08) between the two groups. During mid to long-term follow up (6-months to 5-years), there were no significant differences between ViV-TAVR and redo-SAVR for all-cause mortality, cardiovascular mortality and stroke. ViV-TAVR was, however, associated with higher risk of prosthesis-patient mismatch and greater transvalvular pressure gradient post-implantation.
ViV-TAVR compared to redo-SAVR appears to be associated with significant improvement in short term mortality and major bleeding. For mid to long-term follow up, the outcomes were similar for both groups.
对于生物人工心脏主动脉瓣退化的患者，经导管主动脉瓣置换术（ViV-TAVR）与再次外科主动脉瓣置换术（redo-SAVR）的疗效和安全性对比尚不明确。
检索数字数据库以识别相关文章。使用随机效应模型计算二分结果的未调整优势比。共纳入11项研究，涉及8326例患者（ViV-TAVR组 = 4083例，redo-SAVR组 = 4243例）。
接受ViV-TAVR的患者平均年龄更大，为76岁，而接受SAVR的患者平均年龄为73岁。ViV-TAVR组与redo-SAVR组患者的基线特征具有可比性。在30天时，与redo-SAVR相比，接受ViV-TAVR的患者全因死亡（OR 0.45，95% CI 0.30 - 0.68，p = 0.0002）、心血管死亡（OR 0.44，95% CI 0.26 - 0.73，p = 0.001）和大出血（OR 0.29，95% CI 0.15 - 0.54，p = 0.0001）的几率显著更低。两组在脑血管意外（OR 0.91，95% CI 0.52 - 1.58，p = 0.74）、心肌梗死（OR 0.92，95% CI 0.44 - 1.92，p = 0.83）和永久性起搏器植入（PPM）（OR 0.54，95% CI 0.27 - 1.07，p = 0.08）的几率方面无显著差异。在中长期随访（6个月至5年）期间，ViV-TAVR与redo-SAVR在全因死亡、心血管死亡和中风方面无显著差异。然而，ViV-TAVR与人工瓣膜 - 患者不匹配风险较高以及植入后跨瓣压差较大相关。
与redo-SAVR相比，ViV-TAVR似乎与短期死亡率和大出血的显著改善相关。对于中长期随访，两组结果相似。
