Altaii Haider, Morcos Ramez, Riad Fady, Abdulameer Halah, Khalili Houman, Maini Brijeshwar, Lieberman Eric, Vivas Yoel, Wiegn Phi, A Joglar Jose, Mackall Judith, G Al-Kindi Sadeer, Thal Sergio
Division of Cardiology, Florida Atlantic University, Boca Raton, FL.
Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH.
J Atr Fibrillation. 2020 Dec 31;13(4):2411. doi: 10.4022/jafib.2411. eCollection 2020 Dec.
Post-operative atrial fibrillation (POAF) is common after aortic valve replacement (AVR) and is associated with worse outcomes. We performed a meta-analysis of randomized controlled trials comparing Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) for incidence of POAF at 30 days.
We searched databases from 1/1/1990 to 1/1/2020 for randomized studies comparing TAVR and SAVR. POAF was defined as either worsening or new-onset atrial fibrillation. Random effects model was used to estimate the risk of POAF with TAVR vs SAVR in all trials, and in subgroups (low, intermediate, high risk, and in self-expandable vs balloon expandable valves). Sensitivity analysis was performed including only studies reporting new-onset atrial fibrillation.
Seven RCTs were identified that enrolled 7,934 patients (3,999 to TAVR and 3,935 to SAVR). The overall incidence of POAF was 9.7% after TAVR and 33.3% after SAVR. TAVR was associated with a lower risk of POAF compared with SAVR (OR 0.21 [0.18-0.24]; P < 0.0001). Compared with SAVR, TAVR was associated with a significantly lower risk of POAF in the high-risk cohort (OR 0.37 [0.27-0.49]; P < 0.0001), in the intermediate-risk cohort (OR 0.23 [0.19-0.28]; P < 0.0001), low-risk cohort (OR 0.13 [0.10-0.16]; P < 0.0001). Sensitivity analysis of 4 trials including only new-onset POAF showed similar summary estimates (OR 0.21, 95% CI [0.18-0.25]; P< 0.0001).
TAVR is associated with a significantly lower risk of post-operative atrial fibrillation compared with SAVR in all strata. Further studies are needed to identify the contribution of post-operative atrial fibrillation to the differences in clinical outcomes after TAVR and SAVR.
术后房颤（POAF）在主动脉瓣置换术（AVR）后很常见，且与更差的预后相关。我们对比较外科主动脉瓣置换术（SAVR）和经导管主动脉瓣置换术（TAVR）术后30天POAF发生率的随机对照试验进行了荟萃分析。
我们检索了1990年1月1日至2020年1月1日的数据库，以查找比较TAVR和SAVR的随机研究。POAF被定义为房颤病情恶化或新发房颤。采用随机效应模型估计所有试验以及亚组（低、中、高风险组，以及自膨胀瓣膜与球囊扩张瓣膜组）中TAVR与SAVR相比发生POAF的风险。进行了敏感性分析，仅纳入报告新发房颤的研究。
共确定了7项随机对照试验，纳入7934例患者（3999例接受TAVR，3935例接受SAVR）。TAVR术后POAF的总体发生率为9.7%，SAVR术后为33.3%。与SAVR相比，TAVR发生POAF的风险更低（比值比0.21 [0.18 - 0.24]；P < 0.0001）。与SAVR相比，TAVR在高风险队列（比值比0.37 [0.27 - 0.49]；P < 0.0001）、中风险队列（比值比0.23 [0.19 - 0.28]；P < 0.0001）、低风险队列（比值比0.13 [0.10 - 0.16]；P < 0.0001）中发生POAF的风险均显著更低。对仅包括新发POAF的4项试验进行的敏感性分析显示了相似的汇总估计值（比值比0.21，95%置信区间[0.18 - 0.25]；P < 0.0001）。
在所有分层中，与SAVR相比，TAVR术后房颤风险显著更低。需要进一步研究以确定术后房颤对TAVR和SAVR术后临床结局差异的影响。
