二叶式主动脉瓣和三叶式主动脉瓣患者行保留瓣膜主动脉根部替换术的结局：系统评价和荟萃分析。

Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis.

机构信息

Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, China.

Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, 610041, China.

出版信息

J Cardiothorac Surg. 2023 Jul 3;18(1):206. doi: 10.1186/s13019-023-02329-8.

DOI:10.1186/s13019-023-02329-8

PMID:37400892

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10318800/

Abstract

BACKGROUND

Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV).

DESIGN

Meta-analysis with meta-regression and systematic review.

SETTING

Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase.

INTERVENTIONS

All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes.

RESULT

Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time.

CONCLUSION

The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.

摘要

背景

保留瓣膜的主动脉根部替换术（VSARR）是一种安全有效的治疗主动脉根部瘤的手术方法。本荟萃分析旨在探讨在二叶式主动脉瓣（BAV）和三叶式主动脉瓣（TAV）患者中，该手术方法可能存在哪些差异。

设计

荟萃分析，包括荟萃回归和系统评价。

设置

在以下数据库中进行系统搜索：PubMed、Cochrane 对照试验中心注册库和 Embase。

干预措施

我们的研究纳入了所有关于 BAV 或 TAV 患者行 VSARR 的观察性研究。研究纳入时没有语言或出版日期的限制。对主要结局进行了试验序贯分析和事后荟萃回归。

结果

11 篇文章符合纳入标准。BAV 组共 1138 例患者，TAV 组共 2125 例患者。BAV 和 TAV 患者在性别和年龄方面无显著差异。BAV 和 TAV 患者的院内死亡率[0.00% vs. 1.93%；RR（95%CI）0.33（0.09，1.26），I=0%，P=0.11]和院内再次手术率[5.64% vs. 5.99%；RR（95%CI）1.01（0.59，1.73），I=33%，P=0.98]无显著差异。BAV 患者的总体长期死亡率优于 TAV 患者[1.63% vs. 8.15%；RR（95%CI）0.34（0.13，0.86），I=0%，P=0.02]。在随访观察期间，TAV 组患者在 3 年、5 年和 10 年以上的再次干预发生率方面表现出微小但无统计学意义的优势。关于次要终点，两组主动脉阻断时间和总体外循环时间相似。

结论

VSARR 技术在 BAV 和 TAV 患者中的临床结果相似。尽管 BAV 患者在初始 VSARR 后再次介入的发生率较高，但它仍然是一种安全有效的治疗主动脉根部扩张伴或不伴主动脉瓣关闭不全的方法。TAV 患者在长期（10 年以上）再次干预率方面表现出微小但无统计学意义的优势，这意味着 BAV 患者在临床上可能面临更高的再次干预风险。