Lang Zekun, Zhu Youqi, Jiang Gaxue, Ji Pengfei, Zhang Xiaoqi, Zhang Yurong, Sun Xince, Bai Ming
The First Clinical Medical College of Lanzhou University, 730000 Lanzhou, Gansu, China.
The First Hospital of Lanzhou University, Heart Center, Gansu Provincial Cardiovascular Disease Clinical Medical Research Center, Gansu Provincial Key Laboratory of Cardiovascular Disease, 730000 Lanzhou, Gansu, China.
Rev Cardiovasc Med. 2023 Apr 18;24(4):116. doi: 10.31083/j.rcm2404116. eCollection 2023 Apr.
To assess whether there are differences in common postoperative complications and survival between men and women after transcatheter aortic valve implantation.
We searched the Cochrane Library, PubMed, Embase, and the Web of Science from January 2000 to August 2022. Gender-related articles reporting complications and mortality after transcatheter aortic valve implantation were identified. The primary outcomes were the thirty-day mortality, one-year mortality and perivalvular leakage. The secondary outcomes were conversion to open heart surgery during operation, ejection fraction after operation, reintervention and other common postoperative complications. Data were pooled using the risk ratio or standardized mean difference with 95% confidence interval. Subgroup analysis, meta-regression, sensitivity analysis, egger's test and begg's test were performed. The original study protocol was registered prospectively with PROSPERO (CRD42021245858).
There were 24 studies, a total of 92,499 patients, enrolled in our systematic review and meta-analysis, including 43,948 men and 48,551 women. Comprehensive analysis showed significant differences in gender in postoperative complications and survival after transcatheter aortic valve implantation. Men had a significantly higher risk of perivalvular leakage (risk ratio (RR) = 1.42; 95% CI: 1.15 to 1.75; = 0.001; = 68%), but lower risk in bleeding (RR = 0.69; 95% CI: 0.61 to 0.79; 0.00001; = 82%), vascular complications (RR = 0.56; 95% CI: 0.52 to 0.61; 0.00001; = 48%), and stroke (RR = 0.86; 95% CI: 0.80 to 0.93; 0.00001; = 12%). The thirty-day mortality of men is slightly lower than that of women (RR = 0.87; 95% CI: 0.81 to 0.93; = 0.0001; = 47%), the difference in one-year mortality was also significant (RR = 1.20; 95% CI: 1.08 to 1.33; = 0.0008; = 59%). Univariate meta-regression analyses showed that pulmonary hypertension is the major source of heterogeneity in bleeding.
Men after transcatheter aortic valve implantation have a lower risk of related postoperative complications, but a higher risk of paravalvular leak and no advantage in medium-term survival.
评估经导管主动脉瓣植入术后男性和女性在常见术后并发症及生存率方面是否存在差异。
我们检索了2000年1月至2022年8月的Cochrane图书馆、PubMed、Embase和科学网。识别出报告经导管主动脉瓣植入术后并发症和死亡率的性别相关文章。主要结局为30天死亡率、1年死亡率和瓣周漏。次要结局为术中转为心脏直视手术、术后射血分数、再次干预及其他常见术后并发症。使用风险比或标准化均数差及95%置信区间对数据进行汇总。进行亚组分析、Meta回归、敏感性分析、Egger检验和Begg检验。原始研究方案已在PROSPERO（CRD42021245858）上进行前瞻性注册。
我们的系统评价和Meta分析纳入了24项研究，共92499例患者，其中男性43948例，女性48551例。综合分析显示，经导管主动脉瓣植入术后并发症和生存率在性别上存在显著差异。男性瓣周漏风险显著更高（风险比（RR）=1.42；95%置信区间：1.15至1.75；P=0.001；I²=68%），但出血（RR=0.69；95%置信区间：0.61至0.79；P<0.00001；I²=82%）、血管并发症（RR=0.56；95%置信区间：0.52至0.61；P<0.00001；I²=48%）和中风（RR=0.86；95%置信区间：0.80至0.93；P<0.00001；I²=12%）风险较低。男性30天死亡率略低于女性（RR=0.87；95%置信区间：0.81至0.93；P=0.0001；I²=47%），1年死亡率差异也有统计学意义（RR=1.20；95%置信区间：1.08至1.33；P=0.0008；I²=59%）。单因素Meta回归分析显示，肺动脉高压是出血异质性的主要来源。
经导管主动脉瓣植入术后男性术后相关并发症风险较低，但瓣周漏风险较高，且中期生存无优势。
