文献检索，用中文搜 PubMed

Background There is a concern that resheathing/repositioning of transcatheter heart valves during transcatheter aortic valve implantation (TAVI) may lead to an increased risk of periprocedural complications. We aimed to evaluate the short- and long-term impact on clinical outcomes of resheathing for repositioning of transcatheter heart valves during TAVI procedures. Methods and Results We conducted a systematic search of Embase, MEDLINE, and Cochrane Central Register of Controlled Trials databases to identify studies comparing outcomes between patients requiring resheathing/repositioning during TAVI and those who did not. Random-effects meta-analyses were used to estimate the association of resheathing compared with no resheathing with clinical outcomes after TAVI. Seven studies including 4501 participants (pooled mean age, 80.9±7.4 years; 54% women; and 1374 [30.5%] patients requiring resheathing/repositioning) were included in this study. No significant differences between the 2 groups were identified with regards to safety: 30-day mortality (n=3125; odds ratio [OR], 0.74 [95% confidence interval [CI], 0.41-1.33]; =0%), stroke (n=4121; OR, 1.09 [95% CI, 0.74-1.62]; =0%), coronary obstruction (n=3000; OR, 2.35 [95% CI, 0.17-33.47]; =75%), major vascular complications (n=3125; OR, 0.92 [95% CI, 0.66-1.33]; =0%), major bleeding (n=3125; OR, 1.13 [95% CI, 0.94-2.01]; =39%), acute kidney injury (n=3495; OR, 1.30 [95% CI, 0.64-2.62]; =44%), and efficacy outcomes: device success (n=1196; OR, 0.77 [95% CI, 0.51-1.14]; =0%), need for a second valve (n=3170; OR, 2.86 [95% CI, 0.96-8.48]; =62%), significant (moderate or higher) paravalvular leak (n=1151; OR, 1.53 [95% CI, 0.83-2.80]; =0%), and permanent pacemaker implantation (n=1908; OR, 1.04 [95% CI, 0.68-1.57]; =58%). One-year mortality was similar between groups (n=1972; OR, 1.00 [95% CI, 0.68-1.47]; =0%). Conclusions Resheathing of transcatheter heart valves during TAVI is associated with similar periprocedural risk compared with no resheathing in several patient-important outcomes. These data support the safety of current self-expanding transcatheter heart valves with resheathing features. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021273715.

背景

经导管主动脉瓣置换术（TAVI）期间重新护套/重新定位经导管心脏瓣膜可能会增加围手术期并发症的风险。我们旨在评估重新护套对 TAVI 手术期间经导管心脏瓣膜重新定位的临床结果的短期和长期影响。

方法和结果

我们对 Embase、MEDLINE 和 Cochrane 对照试验中心注册数据库进行了系统搜索，以确定比较 TAVI 期间需要重新护套/重新定位的患者与不需要重新护套/重新定位的患者之间结局的研究。使用随机效应荟萃分析来估计与不重新护套相比，重新护套与 TAVI 后临床结局的相关性。这项研究纳入了 7 项研究共 4501 名参与者（汇总平均年龄为 80.9±7.4 岁；54%为女性；1374 [30.5%]名患者需要重新护套/重新定位）。两组在安全性方面没有显著差异：30 天死亡率（n=3125；优势比 [OR]，0.74 [95%置信区间 [CI]，0.41-1.33]；=0%）、卒中（n=4121；OR，1.09 [95% CI，0.74-1.62]；=0%）、冠状动脉阻塞（n=3000；OR，2.35 [95% CI，0.17-33.47]；=75%）、主要血管并发症（n=3125；OR，0.92 [95% CI，0.66-1.33]；=0%）、大出血（n=3125；OR，1.13 [95% CI，0.94-2.01]；=39%）、急性肾损伤（n=3495；OR，1.30 [95% CI，0.64-2.62]；=44%）和疗效结局：器械成功率（n=1196；OR，0.77 [95% CI，0.51-1.14]；=0%）、需要第二个瓣膜（n=3170；OR，2.86 [95% CI，0.96-8.48]；=62%）、显著（中度或更高）瓣周漏（n=1151；OR，1.53 [95% CI，0.83-2.80]；=0%）和永久性起搏器植入（n=1908；OR，1.04 [95% CI，0.68-1.57]；=58%）。两组 1 年死亡率相似（n=1972；OR，1.00 [95% CI，0.68-1.47]；=0%）。