主动脉瓣钙化的数量和位置可预测经导管主动脉瓣置换术后瓣周漏：一项系统评价和荟萃分析。
Quantity and location of aortic valve calcification predicts paravalvular leakage after transcatheter aortic valve replacement: a systematic review and meta-analysis.
作者信息
Shi Jiale, Li Wei, Zhang Tangshan, Han Chengwen, Wang Zhengjun, Pei Xinhao, Li Xuetao, Zhao Zidong, Wang Pengbo, Han Jingying, Chen Shiqiao
机构信息
Shandong Provincial Hospital, Shandong University, Jinan, China.
Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China.
出版信息
Front Cardiovasc Med. 2023 May 24;10:1170979. doi: 10.3389/fcvm.2023.1170979. eCollection 2023.
INTRODUCTION
Transcatheter aortic valve replacement (TAVR) is the first-line treatment for patients with moderate-to-high surgical risk of severe aortic stenosis. Paravalvular leakage (PVL) is a serious complication of TAVR, and aortic valve calcification contributes to the occurrence of PVL. This study aimed to investigate the effect of location and quantity of calcification in the aortic valve complex (AVC) and left ventricular outflow tract (LVOT) on PVL after TAVR.
METHOD
We performed a systematic review and meta-analysis to evaluate the effect of quantity and location of aortic valve calcification on PVL after TAVR using observational studies from PubMed and EMBASE databases from inception to February 16, 2022.
RESULTS
Twenty-four observational studies with 6,846 patients were included in the analysis. A high quantity of calcium was observed in 29.6% of the patients; they showed a higher risk of significant PVL. There was heterogeneity between studies (I2 = 15%). In the subgroup analysis, PVL after TAVR was associated with the quantity of aortic valve calcification, especially those located in the LVOT, valve leaflets, and the device landing zone. A high quantity of calcium was associated with PVL, regardless of expandable types or MDCT thresholds used. However, for valves with sealing skirt, the amount of calcium has no significant effect on the incidence of PVL.
CONCLUSION
Our study elucidated the effect of aortic valve calcification on PVL and showed that the quantity and location of aortic valve calcification can help predict PVL. Furthermore, our results provide a reference for the selection of MDCT thresholds before TAVR. We also showed that balloon-expandable valves may not be effective in patients with high calcification, and valves with sealing skirts instead of those without sealing skirts should be applied more to prevent PVL from happening.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=354630, identifier: CRD42022354630.
引言
经导管主动脉瓣置换术（TAVR）是中重度手术风险的严重主动脉瓣狭窄患者的一线治疗方法。瓣周漏（PVL）是TAVR的一种严重并发症，主动脉瓣钙化会导致PVL的发生。本研究旨在探讨主动脉瓣复合体（AVC）和左心室流出道（LVOT）钙化的位置和数量对TAVR术后PVL的影响。
方法
我们进行了一项系统评价和荟萃分析，使用来自PubMed和EMBASE数据库从创建到2022年2月16日的观察性研究，评估主动脉瓣钙化的数量和位置对TAVR术后PVL的影响。
结果
分析纳入了24项观察性研究，共6846例患者。29.6%的患者观察到大量钙；他们发生显著PVL的风险更高。研究之间存在异质性（I2 = 15%）。在亚组分析中，TAVR术后PVL与主动脉瓣钙化的数量有关，尤其是位于LVOT、瓣叶和器械着陆区的钙化。无论使用的可扩张类型或MDCT阈值如何，大量钙都与PVL有关。然而，对于有密封裙边的瓣膜，钙的数量对PVL的发生率没有显著影响。
结论
我们的研究阐明了主动脉瓣钙化对PVL的影响，并表明主动脉瓣钙化的数量和位置有助于预测PVL。此外，我们的结果为TAVR术前MDCT阈值的选择提供了参考。我们还表明，球囊扩张瓣膜对钙化程度高的患者可能无效，应更多地应用有密封裙边而非无密封裙边的瓣膜以防止PVL的发生。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=354630，标识符：CRD42022354630。
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