自膨式经导管主动脉瓣置换术中瓣叶重叠投影与标准三尖瓣共面视图的比较：一项系统评价和荟萃分析。
Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis.
作者信息
Chen Yujing, Zhu Gangjie, Liu Xin, Wu Weilin, Chai Hui, Tao Minjie, Kong Dongmei, Li Yingzi, Wang Li
机构信息
Department of Hepatobiliary Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
出版信息
Front Cardiovasc Med. 2022 Aug 17;9:927642. doi: 10.3389/fcvm.2022.927642. eCollection 2022.
OBJECTIVE
Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Recently, the cusp-overlap projection (COP) technique was thought to be a feasible method to reduce PPI risk. However, the evidence is still relatively scarce. Therefore, this meta-analysis was performed to compare COP and standard three-cusp coplanar (TCC) projection technique.
METHODS
PubMed and EMBASE databases were systematically searched for relevant literature published from the inception (EMBASE from 1974 and PubMed from 1966) to 16 April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome of interest was post-operative (including in-hospital and 30-day) PPI.
RESULTS
Total of 3,647 subjects from 11 studies were included in this meta-analysis. Of those, 1,453 underwent self-expanding TAVR using COP and 2,194 using TCC technique. In a pooled analysis, the cumulative PPI incidence was 9.3% [95% confidence interval (CI): 6.9-11.7%] and 18.9% (95% CI: 15.5-22.3%) in the COP group and TCC group, respectively. The application of the COP technique was associated with a significant PPI risk reduction ( = 40.3% and heterogeneity Chi-square = 0.070, random-effects OR: 0.49, 95% CI: 0.36-0.66, < 0.001). A higher implantation depth was achieved in the COP group compared with the TCC group [standardized mean difference (SMD) = -0.324, 95% CI: (-0.469, -0.180)]. There was no significant difference between the two groups in second valve implantation, prosthesis pop-out, fluoroscopic time, post-operative left bundle branch block, mortality, stroke, moderate/severe paravalvular leakage, mean gradient, and length of hospital stay. However, radiation doses were higher in the COP group [SMD = 0.394, 95% CI: (0.216, 0.572), < 0.001].
CONCLUSION
In self-expanding TAVR, the application of the cusp overlap projection technique was associated with a lower risk of PPI compared with the standard TCC technique.
SYSTEMATIC REVIEW REGISTRATION
[https://inplasy.com/inplasy-2022-4-0092/], identifier [INPLASY202240092].
目的
永久起搏器植入（PPI）是经导管主动脉瓣置换术（TAVR）后的常见并发症。最近，瓣叶重叠投影（COP）技术被认为是一种降低PPI风险的可行方法。然而，相关证据仍然相对较少。因此，进行了这项荟萃分析以比较COP和标准三尖瓣共面（TCC）投影技术。
方法
按照系统评价和荟萃分析的首选报告项目（PRISMA）声明，对PubMed和EMBASE数据库进行系统检索，以查找从起始（EMBASE始于1974年，PubMed始于1966年）至2022年4月16日发表的相关文献。感兴趣的主要结局是术后（包括住院期间和30天）PPI。
结果
本荟萃分析纳入了来自11项研究的3647名受试者。其中，1453例使用COP进行自膨胀TAVR，2194例使用TCC技术。在汇总分析中，COP组和TCC组的累积PPI发生率分别为9.3%[95%置信区间（CI）：6.9 - 11.7%]和18.9%（95%CI：15.5 - 22.3%）。COP技术的应用与显著降低PPI风险相关（风险降低 = 40.3%，异质性卡方 = 0.070，随机效应OR：0.49，95%CI：0.36 - 0.66，P < 0.）。与TCC组相比，COP组实现了更高的植入深度[标准化均数差（SMD）= -0.324，95%CI：（-0.469，-0.180）]。两组在二次瓣膜植入、人工瓣膜弹出、透视时间、术后左束支传导阻滞、死亡率、中风、中度/重度瓣周漏、平均压差和住院时间方面无显著差异。然而，COP组的辐射剂量更高[SMD = 0.394，95%CI：（0.216，0.572），P < 0.001]。
结论
在自膨胀TAVR中，与标准TCC技术相比，瓣叶重叠投影技术的应用与较低的PPI风险相关。
系统评价注册
[https://inplasy.com/inplasy-2022-4-0092/]，标识符[INPLASY202240092]
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