摘要
目的评估经导管主动脉瓣置换术治疗主动脉瓣关闭不全的有效性及安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、中国知网、万方和维普数据库,检索时限均从建库至2021年8月。由2名研究员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的质量,然后,采用Stata 16.0软件进行Meta分析。根据使用瓣膜的种类、研究类型进行亚组分析。结果最终纳入25篇文献,其中12篇文献为队列研究、13篇文献为单臂研究,共4370例患者。Meta分析结果显示:成功率为87%[95%CI(0.81,0.92)]。亚组分析,新一代瓣膜的成功率为93%[95%CI(0.89,0.96)],早一代瓣膜的成功率为66%[95%CI(0.56,0.75)]。此外术后30 d死亡率为7%[95%CI(0.05,0.10)],术后30 d心源性死亡率为4%[95%CI(0.01,0.07)],术后起搏器植入率为10%[95%CI(0.08,0.13)],中转开胸率为2%[95%CI(0.01,0.04)],术后中度及重度瓣膜反流率为6%[95%CI(0.03,0.09)]。结论应用经导管主动脉瓣置换术治疗主动脉瓣关闭不全安全有效。但由于本研究存在一定的局限性,结果还需大样本量的随机对照试验进一步验证。
Objective To investigate effectiveness and safety of transcatheter aortic valve replacement in the treatment of aortic regurgitation.Methods PubMed,EMbase,The Cochrane Library,Web of Science,CNKI,Wanfang Data and VIP were searched from inception to August 2021.According to the criteria of inclusion and exclusion,two reviewers independently screened the literature,extracted the data and evaluated the quality of the included studies.Then,Stata 16.0 software was used for meta-analysis.Subgroup meta-analysis of valve type used and study type was performed.Results Twenty-five studies(12 cohort studies and 13 single-arm studies)were included with 4370 patients.Metaanalysis results showed that an incidence of device success was 87%(95%CI 0.81-0.92).The success rate of the new generation valve subgroup was 93%(95%CI 0.89-0.96),and the early generation valve subgroup was 66%(95%CI 0.56-0.75).In addition,the 30-day all-cause mortality was 7%(95%CI 0.05-0.10),the 30-day cardiac mortality was 4%(95%CI0.01-0.07),the incidence of pacemaker implantation was 10%(95%CI 0.08-0.13),and the incidence of conversion to thoracotomy was 2%(95%CI 0.01-0.04).The incidence of moderate or higher paravalvular aortic regurgitation was 6%(95%CI0.03-0.09).Conclusion Transcatheter aortic valve replacement for aortic regurgitation is safe and yields good results,but some limitations can not be overcome.Therefore,multicenter randomized controlled trials are needed to confirm our results.
作者
陈扬
王珍秀
陈浩
王佳露
刘洪序
万尊慧
董帅
宋兵
CHEN Yang;WANG Zhenxiu;CHEN Hao;WANG Jialu;LIU Hongxu;WAN Zunhui;DONG Shuai;SONG Bing(The First Clinical Medical College of Lanzhou University,Lanzhou,730000,P.R.China;Department of Cardiovascular Surgery,The First Hospital of Lanzhou University,Lanzhou,730000,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2023年第2期240-248,共9页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
甘肃省自然科学基金(20JR10RA689)
兰州大学横向基金[(19)0564]
兰州大学第一临床医学院卓越计划(20200060024)。
作者简介
通信作者:宋兵,Email:songbinldyy@163.com。
