低风险患者经导管主动脉瓣置换术：随机对照试验的最新荟萃分析
Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials.
作者信息
Meeus Roel, Dhondt Pavell, Hariyanto Jesslyn, Ashraf Hadiah, Lecchi Caterina, Fischer-Bacca Caroline O, Langenhoven Leen Van, Minten Lennert, Dubois Christophe
机构信息
Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.
Gedung Fakultas Kedokteran UPH, Tangerang, Indonesia.
出版信息
Int J Cardiol Heart Vasc. 2025 May 3;59:101692. doi: 10.1016/j.ijcha.2025.101692. eCollection 2025 Aug.
BACKGROUND
Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic valve stenosis (AS) at low risk for surgical aortic valve replacement (SAVR), despite uncertainty regarding medium and long-term clinical outcomes.
OBJECTIVES
We performed an updated meta-analysis comparing TAVR with SAVR in this population.
METHODS
We searched PubMed, EMBASE and Cochrane Central for randomized controlled trials (RCT) comparing TAVR with SAVR in low-risk patients with either bicuspid or tricuspid AS. Outcomes of interest were all-cause mortality, rehospitalization and stroke at 30 days, 1 year and up to 5 years follow-up.
RESULTS
We included six RCTs with in total 4487 patients, mean age 74.2 ± 5.5y and of which 50.1 % underwent TAVR. The STS-PROM Score was similar for TAVR and SAVR (2.1 ± 0.7 vs. 2.2 ± 0.8 %). Thirty-day all-cause mortality showed a borderline significant difference favoring TAVR (RR 0.55; 95 % CI 0.30-1.01; p = 0.05). One-year all-cause mortality was significantly lower for TAVR (RR 0.60; 95 % CI 0.41-0.98; p = 0.01), while no differences were seen at 5-year follow up (RR 1.02; 95 % CI 0.81-1.29; p = 0.85). TAVR was associated with reduced 30-day (RR 0.67; 95 % CI 0.46-0.95; p = 0.03) and one-year rehospitalization rates (RR 0.72; 95 % CI 0.53-0.98; p = 0.04). Stroke rates at 30 days (RR 0.78; 95 % CI 0.48-1.32; p = 0.37), one-year (RR 0.79; 95 % CI 0.48-1.32; p = 0.37) and 5-year follow-up (RR 1.09; 95 % CI 0.81-1.46; p = 0.56) were not significantly different.
CONCLUSIONS
TAVR in low-risk patients with AS results in reduced 1-year all-cause mortality and rehospitalization rates as compared with SAVR. This benefit is attenuated during protracted follow-up.
背景
经导管主动脉瓣置换术（TAVR）越来越多地用于外科主动脉瓣置换术（SAVR）低风险的主动脉瓣狭窄（AS）患者，尽管中长期临床结局尚不确定。
目的
我们进行了一项更新的荟萃分析，比较该人群中TAVR与SAVR的疗效。
方法
我们检索了PubMed、EMBASE和Cochrane中心，查找比较TAVR与SAVR用于双叶或三叶AS低风险患者的随机对照试验（RCT）。感兴趣的结局为30天、1年及长达5年随访时的全因死亡率、再住院率和卒中发生率。
结果
我们纳入了6项RCT，共4487例患者，平均年龄74.2±5.5岁，其中50.1%接受了TAVR。TAVR和SAVR的胸外科医师协会预测风险（STS-PROM）评分相似（2.1±0.7对2.2±0.8%）。30天全因死亡率显示TAVR有临界显著差异（风险比[RR]0.55；95%置信区间[CI]0.30-1.01；p=0.05）。TAVR的1年全因死亡率显著更低（RR0.60；95%CI0.41-0.98；p=0.01），而5年随访时未见差异（RR1.02；95%CI0.81-1.29；p=0.85）。TAVR与30天（RR0.67；95%CI0.46-0.95；p=0.03）和1年再住院率降低相关（RR0.72；95%CI0.53-0.98；p=0.04）。30天（RR0.78；95%CI0.48-1.32；p=0.37）、1年（RR0.79；95%CI0.48-1.32；p=0.37）和5年随访时的卒中发生率无显著差异（RR1.09；95%CI0.81-1.46；p=0.56）。
结论
与SAVR相比，AS低风险患者行TAVR可降低1年全因死亡率和再住院率。在长期随访中，这种益处会减弱。
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