Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China; Medical College of Yangzhou University, Yang zhou, 225001, China; Northern Jiangsu People's Hospital, Yang zhou, 225001, China.
Taizhou People's Hospital affiliated towith Nanjing Medical University, Taizhou, 225300, China.
Heart Lung. 2025 Jan-Feb;69:62-70. doi: 10.1016/j.hrtlng.2024.09.011. Epub 2024 Sep 24.
The application of transcatheter aortic valve replacement (TAVR) has been developed on different populations in many clinical studies. However, research dedicated to the application of emergency TAVR in patients with aortic stenosis (AS) experiencing cardiogenic shock is limited.
To investigate the safety and effectiveness of emergency TAVR in AS patients with circulatory collapse.
Studies on the application of emergency TAVR in AS patients with cardiogenic shock were screened from PubMed, Web of Science, and Embase databases. Two researchers independently screened the literature-extracted data and conducted a meta-analysis was conducted using STATA 16.0 software.
17 studies comprising 36,886 patients undergoing emergency TAVR and 8,530 patients undergoing emergency SAVR or BAV. Emergency TAVR showed no difference in valve implantation success rate compared to elective TAVR. At 30-day endpoints comparison, emergency TAVR exhibited significantly higher all-cause mortality and readmission rates than elective TAVR (RR=2.73 95 %CI 2.04-3.65, P < 0.01; RR=1.2 95 %CI 0.9-1.6, P < 0.01), but reduced mortality risk compared to emergency SAVR/BAV (RD=-0.15 95 %CI -0.25 to -0.04, P = 0.005). At one year post-operation, people with emergency TAVR continued to have higher all-cause mortality than elective TAVR (RR=1.55 95 %CI 1.37-1.74, P < 0.01) but similar with emergency SAVR/BAV (RD=-0.04 95 %CI -0.33 to 0.25, P = 0.796). Rates of severe bleeding and new-onset renal dialysis were higher after emergency TAVR, compared to elective TAVR, while the incidences of permanent pacemaker implantation, severe paravalvular leakage and stroke were similar.
Despite emergency TAVR having higher readmission and mortality rates compared to elective TAVR, it is a relatively safe and effective treatment in cases of cardiogenic shock compared to emergency BAV/SAVR.
经导管主动脉瓣置换术（TAVR）已在许多临床研究中针对不同人群进行了应用。然而，针对发生心源性休克的主动脉瓣狭窄（AS）患者应用紧急 TAVR 的研究有限。
探讨紧急 TAVR 在发生循环衰竭的 AS 患者中的安全性和有效性。
从 PubMed、Web of Science 和 Embase 数据库中筛选出关于 AS 合并心源性休克患者应用紧急 TAVR 的研究。由 2 位研究者独立筛选文献提取数据，并采用 STATA 16.0 软件进行荟萃分析。
共纳入 17 项研究，包含 36886 例行紧急 TAVR 及 8530 例行紧急 SAVR 或 BAV 的患者。与择期 TAVR 相比，紧急 TAVR 的瓣膜植入成功率无差异。在 30 天终点比较中，紧急 TAVR 的全因死亡率和再入院率显著高于择期 TAVR（RR=2.73，95%CI 2.043.65，P<0.01；RR=1.2，95%CI 0.91.6，P<0.01），但低于紧急 SAVR/BAV（RD=-0.15，95%CI -0.25 至 -0.04，P=0.005）。术后 1 年，紧急 TAVR 的全因死亡率仍高于择期 TAVR（RR=1.55，95%CI 1.37~1.74，P<0.01），但与紧急 SAVR/BAV 相似（RD=-0.04，95%CI -0.33 至 0.25，P=0.796）。与择期 TAVR 相比，紧急 TAVR 后严重出血和新发肾脏透析的发生率较高，而永久性起搏器植入、严重瓣周漏和卒中的发生率相似。
与择期 TAVR 相比，紧急 TAVR 虽再入院率和死亡率较高，但与紧急 BAV/SAVR 相比，紧急 TAVR 在心源性休克患者中是一种相对安全且有效的治疗方法。
