摘要
目的通过Meta分析评价经股动脉(transfemoral,TF)、经心尖(transapical,TAp)及经锁骨下动脉(transsubclavian,TSc)3种不同路径行经导管主动脉瓣置换术(TAVR)早期及中期的安全性。方法通过检索PubMed、Web of Science、EMbase及The Cochrane Library等数据库,收集2019年6月前公开发表的TF、TAp、TSc3种不同路径TAVR安全性的临床对照研究,提取各路径术后30 d、1年、2年死亡率以及术后30 d常见并发症发生率(包括起搏器依赖型传导阻滞、主要血管并发症、严重出血事件、急性肾损伤及卒中等),采用RevMan 5.3软件进行Meta分析。结果本研究共纳入11篇文献,共7833例患者,其中TF路径5348例、TAp路径1796例、TSc路径689例。Meta分析结果显示:(1)术后30 d时,TF、TSc路径患者死亡率低于TAp路径(TF vs.TAp:OR=0.57,95%CI 0.39~0.84,P=0.004;TSc vs.TAp:OR=4.12,95%CI 1.93~8.79,P=0.0003),TF与TSc路径之间差异无统计学意义(OR=0.98,95%CI 0.38~2.51,P=0.97);术后1年死亡率3种路径死亡率差异无统计学意义(P>0.05);术后2年死亡率,TSc与TF、TAp路径差异均无统计学意义(TF vs.TSc:OR=1.21,95%CI 0.95~1.54,P=0.13;TSc vs.TAp:OR=1.02,95%CI 0.76~1.36,P=0.91)。(2)TF术后急性肾损伤发生率低于TAp路径(OR=0.30,95%CI 0.22~0.41,P<0.00001)。(3)TSc与TF、TAp路径主要血管并发症差异无统计学意义(TF vs.TSc:OR=0.75,95%CI 0.38~1.49,P=0.41;TSc vs.TAp:OR=1.37,95%CI 0.56~3.32,P=0.49)。(4)TF与TSc路径术后严重出血情况差异无统计学意义(OR=0.97,95%CI 0.53~1.76,P=0.92)。(5)3种路径在术后30 d卒中、起搏器依赖型传导阻滞的发生率之间差异无统计学意义(P>0.05)。结论TAp及TSc路径安全、有效,不仅可作为TF路径的替代方案,在某些髂股动脉条件不佳的患者还可作为首选。
Objective To evaluate the early and mid-term safety of transcatheter aortic valve replacement via transfemoral(TF),transapical(TAp)and transsubclavian(TSc)approaches by meta-analysis.Methods We systematically searched the clinical comparative trials published from inception to June 2019 from PubMed,Web of Science,EMbase and The Cochrane Library,to evaluate the safety of transcatheter aortic valve replacement through TF,TAp or TSc approaches.The information of all-cause mortality at 30 days,1 year,2 years and the incidence of common complications at 30 days after operation(including pacemaker-dependent block,major vascular complications,severe bleeding events,acute renal injury and stroke)were exacted,and a meta-analysis was conducted by RevMan 5.3 software.Results This study included 11 literatures,with a total of 7833 patients,among whom 5348 patients were treated by TF TAVR,1796 patients by TAp TAVR and 689 patients by TSc TAVR.The results of the meta-analysis were as follows:(1)at 30 days after operation,the mortality of TF and TSc approaches were lower than that of the TAp approach(TF vs.TAp:OR=0.57,95%CI 0.39-0.84,P=0.004;TSc vs.TAp:OR=4.12,95%CI 1.93-8.79,P=0.0003).There was no statistical difference between the TF and TSc approaches(TF vs.TSc:OR=0.98,95%CI 0.38-2.51,P=0.97);at 1 year,there was no statistical difference in mortality among the three approaches(P>0.05);at 2 years,there was no statistical difference between TSc and TF or TAp approaches(TF vs.TSc:OR=1.21,95%CI 0.95-1.54,P=0.13;TSc vs.TAp:OR=1.02,95%CI0.76-1.36,P=0.91).(2)The incidence of acute kidney injury after TF approach was lower than that of the TAp approach(OR=0.30,95%CI 0.22-0.41,P<0.00001).(3)There was no statistical difference in major vascular complications between TSc and TF or TAp approaches(TF vs.TSc:OR=0.75,95%CI 0.38-1.49,P=0.41;TSc vs.TAp:OR=1.37,95%CI 0.56-3.32,P=0.49).(4)There was no statistical difference in severe bleeding events between TF and TSc(OR=0.97,95%CI 0.53-1.76,P=0.92).(5)There was no statistical difference in the incidence of postoperative stroke,pacemaker dependent block among the three approaches(P>0.05).Conclusion TAp and TSc approaches are safe and effective.They are not only an alternative to TF approach,but also the first choice in some patients with poor condition of iliofemoral artery.
作者
金力波
吴昊
冯卫中
徐鹏
曾涌
周军庆
JIN Libo;WU Hao;FENG Weizhong;XU Peng;ZENG Yong;ZHOU Junqing(Department of Cardiovascular Surgery,Shaoxing People's Hospital,Shaoxing,312000,Zhejiang,P.R.China;Department of Cardiothoracic Surgery,The Affiliated Hospital of Hangzhou Normal University,Hangzhou,310015,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2021年第7期765-776,共12页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
作者简介
通信作者:吴昊,Email:xiaoleshui@163.com。
