Tzoumas Andreas, Kyriakoulis Ioannis, Ntoumaziou Athina, Sagris Marios, Kampaktsis Polydoros N
Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Catheter Cardiovasc Interv. 2025 Apr;105(5):1012-1023. doi: 10.1002/ccd.31417. Epub 2025 Jan 22.
Patients with prior history of chest or mediastinal radiation are deemed high risk for surgical AVR. Transcatheter aortic valve replacement (TAVR) has emerged as a promising alternative for these patients, however, this patient population was underrepresented in prior TAVR trials.
To compare the outcomes of TAVR in patients with versus without a history of prior chest or mediastinal radiation.
This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic search of electronic databases was conducted up to September 2023. We compared early and late mortality as well as complications. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity.
Seven studies comprising 6358 patients were included in this meta-analysis. Patients undergoing TAVR in the radiation group had a higher risk for heart failure exacerbation (OR: 2.06; 95% CI: 1.18-3.59) and aortic valve reintervention (OR: 5.68; 95% CI: 1.83-17.67) in the early postoperative period compared to the nonradiation group. Analysis revealed similar short-term (in-hospital or 30-day) all-cause-mortality (OR: 1.63; 95% CI: 0.89-2.98) between the two groups. Other perioperative complications including myocardial infarction (MI), stroke, pacemaker insertion requirement, major bleeding as well as access-related complications were not significantly different between the two groups. TAVR in the radiation group was not associated with increased all-cause mortality compared to the nonradiation group (OR: 1.40; 95% CI: 0.93-2.11) after a mean follow-up of 17.6 months. Other endpoints including MI, stroke, need for pacemaker insertion, heart failure readmission rate, and need for aortic valve reintervention were similar in the mid-term follow-up between the two groups.
TAVR in patients with a history of prior chest or mediastinal radiation was associated with similar short-term and mid-term mortality compared to patients without radiation. The history of chest or mediastinal radiation was associated with more frequent heart failure hospitalizations and aortic valve reintervention in the postoperative period. No difference was found in mid-term complications. Future studies are warranted to validate our findings.
有胸部或纵隔放疗史的患者被认为是外科主动脉瓣置换术（AVR）的高风险人群。经导管主动脉瓣置换术（TAVR）已成为这类患者的一种有前景的替代方案，然而，在既往的TAVR试验中，这一患者群体的代表性不足。
比较有和没有胸部或纵隔放疗史的患者接受TAVR的结果。
本研究按照系统评价和Meta分析的首选报告项目指南进行。对电子数据库进行系统检索至2023年9月。我们比较了早期和晚期死亡率以及并发症。采用随机效应模型进行Meta分析。使用I²统计量评估异质性。
本Meta分析纳入了7项研究，共6358例患者。与非放疗组相比，放疗组接受TAVR的患者术后早期心力衰竭加重风险更高（比值比：2.06；95%置信区间：1.18 - 3.59），主动脉瓣再次干预风险更高（比值比：5.68；95%置信区间：1.83 - 17.67）。分析显示两组短期（住院期间或30天）全因死亡率相似（比值比：1.63；95%置信区间：0.89 - 2.98）。其他围手术期并发症，包括心肌梗死（MI）、中风、起搏器植入需求、大出血以及与入路相关的并发症，两组之间无显著差异。在平均随访17.6个月后，与非放疗组相比，放疗组的TAVR与全因死亡率增加无关（比值比：1.40；95%置信区间：0.93 - 2.11）。两组中期随访的其他终点，包括心肌梗死、中风、起搏器植入需求、心力衰竭再入院率以及主动脉瓣再次干预需求相似。
与没有放疗史的患者相比，有胸部或纵隔放疗史的患者接受TAVR的短期和中期死亡率相似。胸部或纵隔放疗史与术后更频繁的心力衰竭住院和主动脉瓣再次干预有关。中期并发症无差异。未来的研究有必要验证我们的发现。
