摘要
目的通过系统分析评价经皮主动脉瓣置换(TAVR)和外科主动脉瓣置换(SAVR)治疗手术低危主动脉瓣狭窄患者的并发症情况,为治疗手术低危的主动脉瓣狭窄提供可靠的循证依据。方法计算机检索Pub Med、中国知网、Cochrane Library、中国生物医学文献数据库、Embase、万方数据库中有关TAVR与SAVR治疗低危主动脉瓣狭窄患者随机对照试验(RCT),检索时间为2010年1月—2019年7月。用Cocharan风险偏倚评估工具对纳入的RCT进行质量评价,并收集各研究中患者的基线特征以及各随访时段结局指标数据。采用Rev Man 5.3对数据进行统计分析。结果共纳入5篇文献,共2957例患者,其中1531例患者接受TAVR治疗,1426例患者接受SAVR治疗。Meta分析结果表明,接受TAVR和SAVR的患者30 d全因死亡率、卒中发生率和短暂性脑缺血发作(TIA)〔RR=0.56,95%CI(0.27,1.14),P=0.11;RR=0.77,95%CI(0.49,1.22),P=0.26;RR=1.27,95%CI(0.44,3.62),P=0.66〕差异均无统计学意义,新发或加重心房颤动和起搏器置入〔RR=0.21,95%CI(0.14,0.31),P<0.00001;RR=5.23,95%CI(1.15,23.71),P=0.03〕差异具有统计学意义;患者术后1年卒中发生率和TIA〔RR=0.71,95%CI(0.49,1.04),P=0.08;RR=1.00,95%CI(0.50,2.01),P=0.99〕差异均无统计学意义,而全因死亡率、新发或加重心房颤动和起搏器置入〔RR=0.60,95%CI(0.39,0.94),P=0.02;RR=0.28,95%CI(0.24,0.34),P<0.00001;RR=5.83,95%CI(2.17,15.70),P=0.0005〕差异具有统计学意义。结论TAVR组和SAVR组在卒中发生率、TIA等结局没有明显差别,TAVR在新发或加重心房颤动等并发症上好于SAVR,而SAVR在起搏器置入等终点上优于TAVR,术后30 d全因死亡率两组之间没有明显差别,但术后1年TAVR要更佳。
Objective The complications of transcatheter aortic valve replacement(TAVR)versus surgical aortic valve replacement(SAVR)in the treatment of aortic stenosis at low risk were systematically analyzed and evaluated,which provided reliable evidence for the treatment of low risk patients.Methods The researchers found the papers from the databases including PubMed,China National Knowledge Internet,Cochrane Library,China Biology Medicine,Embase and Wanfang database for the randomized controlled trials(RCTs)of TAVR in patients comparing with SAVR.The retrieval time is from January 2010 to July 2019.The Cocharan handbook was used to evaluate the quality of the studies and then the baseline characteristics of the patients in each study and the outcome data for each follow-up period were collected.Finally,the RevMan 5.3 was performed to analyse the dates.Results A total of 5 articles were enrolled in this meta-analysis,with 1531 patients(1531 patients in TAVR group and 1423 patients in SAVR).The analysis showed that there were no statistically significant differences in patients between TAVR group and SAVR group with the outcomes of all-cause mortality,stroke and transient ischemic attack(TIA)in 30 days after operation〔RR=0.56,95%CI(0.27,1.14),P=0.11;RR=0.77,95%CI(0.49,1.22),P=0.26;RR=1.27,95%CI(0.44,3.62),P=0.66〕,while new-onset or worsening atrial fibrillation and pacemaker implantation were statistically significant differences in patients〔RR=0.21,95%CI(0.14,0.31),P<0.00001;RR=5.23,95%CI(1.15,23.71),P=0.03〕.The analysis also revealed that there were no statistically significant differences in patients between TAVR group and SAVR group with the outcomes of stroke and TIA in 1 year after operation〔RR=0.71,95%CI(0.49,1.04),P=0.08;RR=1.00,95%CI(0.50,2.01),P=0.99〕,but all-cause mortality,new-onset or worsening atrial fibrillation and pacemaker implantation performed statistically significant differences in patients〔RR=0.60,95%CI(0.39,0.94),P=0.02;RR=0.28,95%CI(0.24,0.34),P<0.00001;RR=5.83,95%CI(2.17,15.70),P=0.0005〕.Conclusion Compared to SAVR,TAVR is associated with similar risks of stroke and TIA.TAVR performs better in terms of new-onset or worsening atrial fibrillation,while there is a trend to reduce at the end point of pacemaker implantation in SAVR.There was no significant difference in all-cause mortality between the two groups at 30 days post-surgery,but TAVR was better at 1 year post-surgery.
作者
戴凯
李志兵
罗雅菲
宋志芳
彭青
DAI Kai;LI Zhibing;LUO Yafei;SONG Zhifang;PENG Qing(Department of Cardiology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《中国全科医学》
CAS
北大核心
2020年第S02期26-30,共5页
Chinese General Practice
基金
江西省教育厅课题(GJJ170046)
江西省卫计委课题(20181024)
关键词
主动脉瓣狭窄
经皮主动脉瓣置换
外科主动脉瓣换瓣
低危
META分析
Aortic valve stenosis
Transcatheter aortic valve replacement
Surgical aortic valve replacement
Low risk
Meta-analysis
作者简介
通信作者:彭青,主治医师,E-mail:824613946@qq.com
