经导管肺动脉瓣植入术后使用Melody瓣膜与Sapien瓣膜的感染性心内膜炎风险：一项前瞻性队列研究的系统评价和荟萃分析
Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.
作者信息
Machanahalli Balakrishna Akshay, Dilsaver Danielle B, Aboeata Ahmed, Gowda Ramesh M, Goldsweig Andrew M, Vallabhajosyula Saraschandra, Anderson Jason H, Simard Trevor, Jhand Aravdeep
机构信息
Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE 68124, USA.
Department of Medicine, Division of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE 68124, USA.
出版信息
J Clin Med. 2023 Jul 25;12(15):4886. doi: 10.3390/jcm12154886.
BACKGROUND
Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in TPVI. Since TPVI patients are typically younger, even a modest annual incidence of infective endocarditis (IE) is significant. Several previous studies have shown a growing risk of IE after TPVI. There is uncertainty regarding the overall incidence of IE and differences in the risk of IE between the valves.
METHODS
A systematic search was conducted in the MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to 1 January 2023 using the search terms 'pulmonary valve implantation', 'TPVI', or 'PPVI'. The primary outcome was the pooled incidence of IE following TPVI in Melody and Sapien valves and the difference in incidence between Sapien and Melody valves. Fixed effect and random effect models were used depending on the valve. Meta-regression with random effects was conducted to test the difference in the incidence of IE between the two valves.
RESULTS
A total of 22 studies (including 10 Melody valve studies, 8 Sapien valve studies, and 4 studies that included both valves (572 patients that used the Sapien valve and 1395 patients that used the Melody valve)) were used for the final analysis. Zero IE incidence following TPVI was reported by eight studies (66.7%) that utilized Sapien valves compared to two studies (14.3%) that utilized Melody valves. The pooled incidence of IE following TPVI with Sapien valves was 2.1% (95% CI: 0.9% to 5.13%) compared to 8.5% (95% CI: 4.8% to 15.2%) following TPVI with Melody valves. Results of meta-regression indicated that the Sapien valve had a 79.6% (95% CI: 24.2% to 94.4%, = 0.019; R = 34.4) lower risk of IE incidence compared to the Melody valve.
CONCLUSIONS
The risk of IE following TPVI differs significantly. A prudent valve choice in favor of Sapien valves to lower the risk of post-TPVI endocarditis may be beneficial.
背景
经导管肺动脉瓣植入术（TPVI）是治疗右心室流出道功能障碍患者的一种有效的非手术治疗方法。美敦力Melody瓣膜和爱德华兹Sapien瓣膜是两种被批准用于TPVI的瓣膜。由于TPVI患者通常较为年轻，即使感染性心内膜炎（IE）的年发病率较低也具有重要意义。此前的多项研究表明，TPVI后IE的风险在不断增加。关于IE的总体发病率以及两种瓣膜之间IE风险的差异尚不确定。
方法
从数据库建立至2023年1月1日，在MEDLINE、EMBASE、PubMed和Cochrane数据库中进行系统检索，检索词为“肺动脉瓣植入术”“TPVI”或“PPVI”。主要结局是Melody瓣膜和Sapien瓣膜TPVI后IE的合并发病率以及Sapien瓣膜和Melody瓣膜之间发病率的差异。根据瓣膜类型使用固定效应模型和随机效应模型。进行随机效应的Meta回归以检验两种瓣膜之间IE发病率的差异。
结果
共有22项研究（包括10项Melody瓣膜研究、8项Sapien瓣膜研究以及4项同时包括两种瓣膜的研究（使用Sapien瓣膜的患者有572例，使用Melody瓣膜的患者有1395例））用于最终分析。在使用Sapien瓣膜的8项研究（66.7%）中报告TPVI后IE发病率为零，而在使用Melody瓣膜的2项研究（14.3%）中报告TPVI后IE发病率为零。使用Sapien瓣膜TPVI后IE的合并发病率为2.1%（95%CI：0.9%至5.13%），而使用Melody瓣膜TPVI后IE的合并发病率为8.5%（95%CI：4.8%至15.2%）。Meta回归结果表明，与Melody瓣膜相比，Sapien瓣膜IE发病率的风险降低了79.6%（95%CI：24.2%至94.4%，P = 0.019；R = 34.4）。
结论
TPVI后IE的风险存在显著差异。谨慎选择Sapien瓣膜以降低TPVI后心内膜炎的风险可能是有益的。
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