Department of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Eur Heart J. 2023 Sep 1;44(33):3168-3177. doi: 10.1093/eurheartj/ehad340.
Heyde syndrome is the co-occurrence of aortic stenosis, acquired von Willebrand syndrome, and gastrointestinal bleeding. Aortic valve replacement has been demonstrated to resolve all three associated disorders. A systematic review and meta-analysis were performed to obtain best estimates of the effect of aortic valve replacement on acquired von Willebrand syndrome and gastrointestinal bleeding.
A literature search was performed to identify articles on Heyde syndrome and aortic valve replacement up to 25 October 2022. Primary outcomes were the proportion of patients with recovery of acquired von Willebrand syndrome within 24 h (T1), 24-72 h (T2), 3-21 days (T3), and 4 weeks to 2 years (T4) after aortic valve replacement and the proportion of patients with cessation of gastrointestinal bleeding. Pooled proportions and risk ratios were calculated using random-effects models. Thirty-three studies (32 observational studies and one randomized controlled trial) on acquired von Willebrand syndrome (n = 1054), and 11 observational studies on gastrointestinal bleeding (n = 300) were identified. One study reported on both associated disorders (n = 6). The pooled proportion of Heyde patients with acquired von Willebrand syndrome recovery was 86% (95% CI, 79%-91%) at T1, 90% (74%-96%) at T2, 92% (84%-96%) at T3, and 87% (67%-96%) at T4. The pooled proportion of Heyde patients with gastrointestinal bleeding cessation was 73% (62%-81%). Residual aortic valve disease was associated with lower recovery rates of acquired von Willebrand syndrome (RR 0.20; 0.05-0.72; P = 0.014) and gastrointestinal bleeding (RR 0.57; 0.40-0.81; P = 0.002).
Aortic valve replacement is associated with rapid recovery of the bleeding diathesis in Heyde syndrome and gastrointestinal bleeding cessation. Residual valve disease compromises clinical benefits.
Heyde 综合征是主动脉瓣狭窄、获得性 von Willebrand 综合征和胃肠道出血同时存在。主动脉瓣置换术已被证实可解决这三种相关疾病。进行了系统评价和荟萃分析，以获得主动脉瓣置换术对获得性 von Willebrand 综合征和胃肠道出血影响的最佳估计。
对截至 2022 年 10 月 25 日的关于 Heyde 综合征和主动脉瓣置换术的文献进行了检索。主要结局是主动脉瓣置换术后 24 小时内（T1）、24-72 小时内（T2）、3-21 天内（T3）和 4 周到 2 年内（T4）获得性 von Willebrand 综合征恢复的患者比例，以及胃肠道出血停止的患者比例。使用随机效应模型计算汇总比例和风险比。共纳入 33 项获得性 von Willebrand 综合征研究（n=1054）和 11 项胃肠道出血研究（n=300），其中 1 项研究同时报告了这两种相关疾病（n=6）。获得性 von Willebrand 综合征恢复的 Heyde 患者的汇总比例为 T1 时 86%（95%CI，79%-91%），T2 时 90%（74%-96%），T3 时 92%（84%-96%），T4 时 87%（67%-96%）。Heyde 患者胃肠道出血停止的汇总比例为 73%（62%-81%）。残余主动脉瓣疾病与获得性 von Willebrand 综合征（RR 0.20；0.05-0.72；P=0.014）和胃肠道出血（RR 0.57；0.40-0.81；P=0.002）恢复率较低相关。
主动脉瓣置换术与 Heyde 综合征出血倾向的快速恢复和胃肠道出血停止相关。残余瓣膜疾病会影响临床获益。
