Nso Nso, Emmanuel Kelechi, Nassar Mahmoud, Bhangal Rubal, Enoru Sostanie, Iluyomade Adedapo, Marmur Jonathan D, Ilonze Onyedika J, Thambidorai Senthil, Ayinde Hakeem
Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA.
Department of Medicine, University of Pittsburgh Medical Center Pinnacle, PA, USA.
Int J Cardiol Heart Vasc. 2022 Jan 17;38:100910. doi: 10.1016/j.ijcha.2021.100910. eCollection 2022 Feb.
Patients with aortic stenosis who undergo transcatheter aortic valve replacement/transcatheter aortic valve implantation (TAVR/TAVI) experience a high incidence of pre-existing atrial fibrillation (pre-AF) and new-onset atrial fibrillation (NOAF) post-operatively. This systematic review and meta-analysis aimed to update current evidence concerning the incidence of 30-day mortality, stroke, acute kidney injury (AKI), length of stay (LOS), and early/late bleeding in patients with NOAF or pre-AF who undergo TAVR/TAVI. PubMed, Google Scholar, JSTOR, Cochrane Library, and Web of Science were searched for studies published between January 2012 and December 2020 reporting the association between NOAF/pre-AF and clinical complications after TAVR/TAVI. A total of 15 studies including 158,220 adult patients with TAVI/TAVR and NOAF or pre-AF were identified. Compared to patients in sinus rhythm, patients who developed NOAF had a higher risk of 30-day mortality, AKI, early bleeding events, extended LOS, and stroke after TAVR/TAVI (odds ratio [OR]: 3.18 [95% confidence interval [CI] 1.58, 6.40]) (OR: 3.83 [95% CI 1.18, 12.42]) (OR: 1.70 [95% CI 1.05, 2.74]) (OR: 13.96 [95% CI, 6.41, 30.40]) (OR: 2.51 [95% CI 1.59, 3.97], respectively). Compared to patients in sinus rhythm, patients with pre-AF had a higher risk of AKI and early bleeding episodes after TAVR/TAVI (OR: 2.43 [95% CI 1.10, 5.35]) (OR: 17.41 [95% CI 6.49, 46.68], respectively). Atrial fibrillation is associated with a higher risk of all primary and secondary outcomes. Specifically, NOAF but not pre-AF is associated with a higher risk of 30-day mortality, stroke, and extended LOS after TAVR/TAVI.
接受经导管主动脉瓣置换术/经导管主动脉瓣植入术(TAVR/TAVI)的主动脉瓣狭窄患者术前存在心房颤动(pre-AF)和术后新发心房颤动(NOAF)的发生率很高。本系统评价和荟萃分析旨在更新关于接受TAVR/TAVI的NOAF或pre-AF患者30天死亡率、中风、急性肾损伤(AKI)、住院时间(LOS)以及早期/晚期出血发生率的现有证据。检索了PubMed、谷歌学术、JSTOR、考克兰图书馆和科学网,以查找2012年1月至2020年12月期间发表的报告NOAF/pre-AF与TAVR/TAVI术后临床并发症之间关联的研究。共确定了15项研究,包括158220例接受TAVI/TAVR且患有NOAF或pre-AF的成年患者。与窦性心律患者相比,发生NOAF的患者在TAVR/TAVI术后30天死亡率、AKI、早期出血事件、住院时间延长和中风的风险更高(比值比[OR]:3.18[95%置信区间[CI]1.58,6.40])(OR:3.83[95%CI 1.18,12.42])(OR:1.70[95%CI 1.05,2.74])(OR:13.96[95%CI,6.41,30.40])(OR:2.51[95%CI 1.59,3.97])。与窦性心律患者相比,pre-AF患者在TAVR/TAVI术后发生AKI和早期出血事件的风险更高(OR:2.43[95%CI 1.10,5.35])(OR:17.41[95%CI 6.49,46.68])。心房颤动与所有主要和次要结局的较高风险相关。具体而言,NOAF而非pre-AF与TAVR/TAVI术后30天死亡率、中风和住院时间延长的较高风险相关。