经导管主动脉瓣植入术中脑保护的临床影响。

Clinical impact of cerebral protection during transcatheter aortic valve implantation.

机构信息

Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.

Department of Internal Medicine, Metropolitan Hospital Center, New York, NY, USA.

出版信息

Eur J Clin Invest. 2024 May;54(5):e14166. doi: 10.1111/eci.14166. Epub 2024 Jan 25.

DOI:10.1111/eci.14166

PMID:38269600

Abstract

BACKGROUND

Embolization of debris can complicate transcatheter aortic valve implantation (TAVI) causing stroke. Cerebral embolism protection (CEP) devices can divert or trap debris.

PURPOSE

To evaluate the efficacy of CEP during TAVI vs the standard procedure.

DATA SOURCES

PubMed, SCOPUS and DOAJ 1/01/2014-04/12/2023.

STUDY SELECTION

Randomized and observational studies comparing CEP versus standard TAVI, according to PRISMA.

PRIMARY OUTCOME

stroke.

SECONDARY OUTCOMES

death, bleeding, vascular access complications, acute kidney injury and infarct area.

DATA EXTRACTION

Two investigators independently assessed study quality and extracted data.

DATA SYNTHESIS

Twenty-six articles were included (540.247 patients). The primary endpoint was significantly lower (RR = 0.800 95%CI:0.682-0.940; p = 0.007) with CEP. Similarly, death rates were significantly lower with CEP (RR = 0.610 95%CI:0.482-0.771; p < 0.001). No difference was found for bleeding (RR = 1.053 95%CI:0.793-1.398; p = 0.721), vascular complications (RR = 0.937 95%CI:0.820-1.070; p = 0.334) or AKI (RR = 0.982 95%CI:0.754-1.279; p = 0.891).

CONCLUSIONS

Use of CEP during TAVI is associated with improved outcomes. Future studies will identify patients who benefit most from CEP.

摘要

背景

碎片栓塞可使经导管主动脉瓣植入术（TAVI）复杂化，导致中风。脑栓塞保护（CEP）装置可转移或捕获碎片。

目的

评估 TAVI 期间 CEP 的疗效与标准手术相比。

数据来源

PubMed、SCOPUS 和 DOAJ，1/01/2014-04/12/2023。

研究选择

根据 PRISMA 比较 CEP 与标准 TAVI 的随机和观察性研究。

主要结果

中风。

次要结果

死亡、出血、血管通路并发症、急性肾损伤和梗塞面积。

数据提取

两名调查员独立评估研究质量并提取数据。

数据综合

共纳入 26 篇文章（540.247 例患者）。CEP 的主要终点显著降低（RR=0.800 95%CI：0.682-0.940；p=0.007）。同样，CEP 组的死亡率显著降低（RR=0.610 95%CI：0.482-0.771；p<0.001）。CEP 组的出血率（RR=1.053 95%CI：0.793-1.398；p=0.721）、血管并发症（RR=0.937 95%CI：0.820-1.070；p=0.334）或急性肾损伤（RR=0.982 95%CI：0.754-1.279；p=0.891）无差异。