Connolly John E, Andabili Seyed Hossein Aalaei, Joseph Emily, Resar Jon, Rahman Faisal
Department of Medicine, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Md.
Department of Medicine, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Md.
Am J Med. 2024 Oct;137(10):1008-1011.e1. doi: 10.1016/j.amjmed.2024.05.031. Epub 2024 Jun 13.
Transcatheter aortic valve replacement (TAVR) is accepted as an alternative to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic valve stenosis. Prior studies have shown that TAVR has comparable or superior outcomes to SAVR in intermediate and high-risk patients. However, there is paucity of data about outcome of TAVR vs SAVR in low-surgical-risk patients evaluated at 4 or more years post-procedure.
A systematic review of all published randomized controlled trials comparing TAVR and SAVR in low-risk patients was completed. A random-effects model meta-analysis was performed to study major outcomes, including all-cause mortality, stroke, myocardial infarction, and aortic valve reintervention.
Three randomized trials comprising 2644 patients (1371 TAVR and 1273 SAVR) with a mean age of 74.3 ± 5.8 years were included in this analysis. There was no significant difference in all-cause and cardiovascular mortality, stroke, myocardial infarction, or aortic valve reintervention between the TAVR and SAVR groups at long-term follow-up. Transcatheter aortic valve replacement was associated with higher rate of pacemaker implantation, whereas SAVR was associated with more atrial fibrillation.
At 4 or more years of follow-up, TAVR is safe and has comparable outcomes to SAVR in low-surgical-risk patients. Possibility of TAVR and its risks and benefits should be discussed with low-surgical-risk patients.
经导管主动脉瓣置换术（TAVR）已被公认为是严重症状性主动脉瓣狭窄患者外科主动脉瓣置换术（SAVR）的替代方案。先前的研究表明，在中高危患者中，TAVR的疗效与SAVR相当或更优。然而，关于低手术风险患者在术后4年或更长时间评估TAVR与SAVR疗效的数据较少。
对所有已发表的比较低风险患者TAVR和SAVR的随机对照试验进行系统评价。采用随机效应模型进行荟萃分析，以研究主要结局，包括全因死亡率、中风、心肌梗死和主动脉瓣再次干预。
本分析纳入了三项随机试验，共2644例患者（1371例TAVR和1273例SAVR），平均年龄为74.3±5.8岁。在长期随访中，TAVR组和SAVR组在全因死亡率、心血管死亡率、中风、心肌梗死或主动脉瓣再次干预方面无显著差异。经导管主动脉瓣置换术与更高的起搏器植入率相关，而SAVR与更多的心房颤动相关。
在4年或更长时间的随访中，TAVR在低手术风险患者中是安全的，且疗效与SAVR相当。应与低手术风险患者讨论TAVR的可能性及其风险和益处。
