Gastino Elisa, Scarpanti Matteo, Parolari Alessandro, Barili Fabio
University Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, Università Degli Studi Di Milano, San Donato Milanese, 20097 Milan, Italy.
Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, 20133 Milan, Italy.
J Clin Med. 2025 May 30;14(11):3866. doi: 10.3390/jcm14113866.
: Transcatheter aortic valve implantation (TAVI) is becoming the most important treatment strategy for aortic valve disease. With its dramatic increase, the rate of major complications and the impact of TAVI on long term outcomes is becoming a pressing issue, especially in terms of comparison with surgical aortic valve replacement (SAVR). PVE is a severe complication that can arise post-procedure, leading to significant morbidity and mortality. The aim of this meta-analysis is to compare the incidence of PVE and 30-day mortality rates between TAVI and SAVR. : A comprehensive literature review was conducted, identifying studies that reported the incidence and outcomes of PVE in patients undergoing TAVI and SAVR. The selected studies were assessed for heterogeneity using the χ test and I statistic. A random effect model was applied to account for variability among studies. The Odds Ratios (ORs) for 30-day mortality and the incidence of PVE were calculated. Funnel plots were utilized to assess the reliability of the data and potential publication bias. : The analysis showed no significant difference in 30-day mortality of PVE in TAVI and SAVR, with an OR of 1.29 (CI 0.98-1.69). However, there was a significant difference in the incidence of PVE (HR 0.76, CI 0.61-0.96), with TAVI demonstrating a protective effect attributed to its lesser invasiveness and shorter procedural times. The funnel plots indicated high reliability of the data, with low standard errors and minimal publication bias. : TAVI and SAVR carry similar 30-day mortality rates for patients with PVE; on the other hand, TAVI shows a lower incidence of PVE due to its minimally invasive nature. These findings suggest that TAVI might be a preferable option for certain patient populations, though further randomized clinical trials are needed to confirm these results and address the limitations of the current study.
经导管主动脉瓣植入术（TAVI）正成为主动脉瓣疾病最重要的治疗策略。随着其急剧增加，主要并发症发生率以及TAVI对长期预后的影响正成为一个紧迫问题，尤其是在与外科主动脉瓣置换术（SAVR）比较方面。人工瓣膜心内膜炎（PVE）是术后可能出现的一种严重并发症，会导致显著的发病率和死亡率。本荟萃分析的目的是比较TAVI和SAVR之间PVE的发生率及30天死亡率。
进行了全面的文献综述，确定报告接受TAVI和SAVR患者中PVE发生率及预后的研究。使用χ检验和I统计量评估所选研究的异质性。应用随机效应模型来考虑研究之间的变异性。计算30天死亡率和PVE发生率的比值比（OR）。利用漏斗图评估数据的可靠性和潜在的发表偏倚。
分析显示，TAVI和SAVR的PVE 30天死亡率无显著差异，OR为1.29（可信区间0.98 - 1.69）。然而，PVE发生率存在显著差异（风险比0.76，可信区间0.61 - 0.96），TAVI因其侵入性较小和手术时间较短而显示出保护作用。漏斗图表明数据具有高可靠性，标准误差低且发表偏倚最小。
对于患有PVE的患者，TAVI和SAVR的30天死亡率相似；另一方面，由于其微创性质，TAVI的PVE发生率较低。这些发现表明，对于某些患者群体，TAVI可能是更优选择，不过需要进一步的随机临床试验来证实这些结果并解决当前研究的局限性。
