经导管主动脉瓣置换术入路及其他基线因素对急性肾损伤发生率的影响：系统评价和荟萃分析。
Effect of TAVR Approach and Other Baseline Factors on the Incidence of Acute Kidney Injury: A Systematic Review and Meta-Analysis.
机构信息
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
出版信息
J Interv Cardiol. 2022 Oct 27;2022:3380605. doi: 10.1155/2022/3380605. eCollection 2022.
BACKGROUND
Acute kidney injury (AKI) is a well-known complication following a transcatheter aortic valve replacement (TAVR) and is associated with higher morbidity and mortality.
OBJECTIVE
We aim to compare the risk of developing AKI after transfemoral (TF), transapical (TA), and transaortic (TAo) approaches following TAVR.
METHODS
We searched Medline and EMBASE databases from January 2009 to January 2021. We included studies that evaluated the risk of AKI based on different TAVR approaches. After extracting each study's data, we calculated the risk ratio and 95% confidence intervals using RevMan software 5.4. Publication bias was assessed by the forest plot.
RESULTS
Thirty-six (36) studies, consisting of 70,406 patients undergoing TAVR were included. Thirty-five studies compared TF to TA, and only seven investigations compared TF to TAo. AKI was documented in 4,857 out of 50,395 (9.6%) patients that underwent TF TAVR compared to 3,155 out of 19,721 (16%) patients who underwent TA-TAVR, with a risk ratio of 0.49 (95% CI, 0.36-0.66; p < 0.00001). Likewise, 273 patients developed AKI out of the 1,840 patients (14.8%) that underwent TF-TAVR in contrast to 67 patients out of the 421 patients (15.9%) that underwent TAo-TAVR, with a risk ratio of 0.51 (95% CI, 0.27-0.98; = 0.04). There was no significant risk when we compared TA to TAo approaches, with a risk ratio of 0.89 (95% CI, 0.29-2.75; = 0.84).
CONCLUSION
The risk of post-TAVR AKI is significantly lower in patients who underwent TF-TAVR than those who underwent TA-TAVR or TAo-TAVR.
背景
急性肾损伤（AKI）是经导管主动脉瓣置换术（TAVR）后的一种已知并发症，与更高的发病率和死亡率相关。
目的
我们旨在比较经股（TF）、经心尖（TA）和经主动脉（TAo）入路行 TAVR 后发生 AKI 的风险。
方法
我们检索了 2009 年 1 月至 2021 年 1 月的 Medline 和 EMBASE 数据库。我们纳入了根据不同 TAVR 途径评估 AKI 风险的研究。在提取每项研究的数据后，我们使用 RevMan 软件 5.4 计算风险比和 95%置信区间。通过森林图评估发表偏倚。
结果
纳入了 36 项（36 项）研究，共计 70406 例接受 TAVR 的患者。35 项研究比较了 TF 与 TA，只有 7 项研究比较了 TF 与 TAo。在接受 TF-TAVR 的 50395 例患者中，有 4857 例（9.6%）发生 AKI，而在接受 TA-TAVR 的 19721 例患者中，有 3155 例（16%）发生 AKI，风险比为 0.49（95%CI，0.36-0.66；p<0.00001）。同样，在接受 TF-TAVR 的 1840 例患者中，有 273 例（14.8%）发生 AKI，而在接受 TAo-TAVR 的 421 例患者中，有 67 例（15.9%）发生 AKI，风险比为 0.51（95%CI，0.27-0.98；p=0.04）。比较 TA 与 TAo 途径时，风险无显著差异，风险比为 0.89（95%CI，0.29-2.75；p=0.84）。
结论
与接受 TA-TAVR 或 TAo-TAVR 的患者相比，接受 TF-TAVR 的患者发生 TAVR 后 AKI 的风险显著降低。
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