Khan Kiyan Ghani, Garcia Israel, Rodriguez Ambar, Wright Whitney, Shahid Habiba, Alrashed Abdulrahaman, Pornchai Angsupat, Manoj Mathew P, Fagbamila Oluwaseun, Mylavarapu Maneeth
Department of Internal Medicine, Baqai Medical University, Karachi, Pakistan.
Department of Internal Medicine, St. George's University, West Indies, Grenada.
Ann Med Surg (Lond). 2025 May 21;87(6):3768-3776. doi: 10.1097/MS9.0000000000003275. eCollection 2025 Jun.
INTRODUCTION: The advances and studies carried out in the area have shown that patients with aortic stenosis (AS) undergoing surgical valve replacement (SAVR) did not have encouraging outcomes. This study aims to compare the different risk factors in patients with AS undergoing transcatheter aortic valve replacement (TAVR) vs. SAVR, respectively, to offer options and more favorable results based on the results obtained in patients with these conditions. METHODS: The study was in accordance with the PRISMA guidelines. Studies comparing outcomes of surgical and transaortic catheter valve replacements in adults were included. Descriptive statistics, binary random effects, and continuous random effects were used. statistics were used to assess for heterogeneity. A -value ≤0.05 was considered statistically significant. RESULTS: In total, eight studies with 18 671 patients were included in our study. All-cause mortality (2.48% vs. 3.03%), major bleeding (11.25% vs. 31.05%), and atrial fibrillation (2.39% vs. 50.42%) were lower in TAVR compared to SAVR. Furthermore, odds of all-cause mortality (odds ratio [OR]: 0.79; 95% CI: 0.63-1.00; = 0.05), stroke (OR: 0.71; 95% CI: 0.58-0.87; = 0.0008), and acute kidney injury (AKI) (OR: 0.38; 95% CI: 0.29-0.49; < 0.00001) were lower in the TAVR group compared to the SAVR group. CONCLUSION: TAVR is superior to SAVR and significantly reduces the risks associated with all-cause mortality, stroke, AKI, and other clinical outcomes. Furthermore, additional research is regarding the long-term effects of transcatheter aortic valve replacement.
引言：该领域取得的进展和开展的研究表明，接受外科瓣膜置换术（SAVR）的主动脉瓣狭窄（AS）患者的治疗效果并不理想。本研究旨在比较接受经导管主动脉瓣置换术（TAVR）与SAVR的AS患者的不同风险因素，以便根据这些患者的治疗结果提供更多选择并取得更理想的效果。 方法：本研究遵循PRISMA指南。纳入比较成人外科和经导管主动脉瓣置换术结果的研究。使用描述性统计、二元随机效应和连续随机效应。 统计方法用于评估异质性。P值≤0.05被认为具有统计学意义。 结果：本研究共纳入八项研究，涉及18671例患者。与SAVR相比，TAVR的全因死亡率（2.48%对3.03%）、大出血（11.25%对31.05%）和心房颤动（2.39%对50.42%）更低。此外，与SAVR组相比，TAVR组的全因死亡率（优势比[OR]：0.79；95%置信区间：0.63 - 1.00；P = 0.05）、中风（OR：0.71；95%置信区间：0.58 - 0.87；P = 0.0008）和急性肾损伤（AKI）（OR：0.38；95%置信区间：
0.29 - 0.49；P < 0.00001）的发生几率更低。 结论：TAVR优于SAVR，并显著降低了与全因死亡率、中风、AKI和其他临床结局相关的风险。此外，关于经导管主动脉瓣置换术的长期影响还需要进一步研究。
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