Abstract：
BACKGROUND: Calcific aortic stenosis is the principal indication for transcatheter aortic valve replacement (TAVR). Comorbid mitral annular calcification (MAC) is often present in patients undergoing TAVR. Limited data exist on the impact of MAC on TAVR outcomes. We conducted a systematic review and meta-analysis to explore the effects of MAC and concomitant mitral valve dysfunction (MVD) on TAVR outcomes.
METHODS: A comprehensive literature review was conducted using PubMed, Embase, Google Scholar, ClinicalTrials.gov, Scopus, and OVID for studies until March 20, 2023. Using the random-effects Mantel-Haenszel method, we calculated pooled risk ratios (RRs) and their corresponding 95 % confidence intervals (CIs) for all dichotomous variables.
RESULTS: Six studies comprising 5822 patients (2541 with MAC [severe MAC (>4 mm thickness) 583; non-severe MAC 1958; 400 with MVD; and 1071 without MVD], 3281 without MAC) met inclusion criteria. At 30 days and 1 year, no significant differences were observed between the overall MAC and no MAC groups in terms of mortality, stroke, and permanent pacemaker implantation. However, MAC with MVD was associated with a higher risk of all-cause mortality compared to MAC without MVD at 30 days (RR = 3.43, 95 % CI 2.04-5.76, P < 0.00001) and at 1 year (RR = 2.44, 95 % CI 1.85-3.20, P < 0.00001). Moreover, the risk of cardiovascular mortality was higher in patients with MAC and MVD compared to those with MAC alone (RR = 2.77, 95 % CI 1.89-4.06, P < 0.00001). Additionally, patients with severe MAC had a higher risk of major bleeding at 30 days compared to the non-severe MAC group (RR = 1.33, 95 % CI 1.04-1.69, P = 0.02).
CONCLUSIONS: TAVR appears to be safe in patients with non-severe MAC, but severe MAC is associated with a higher risk of major bleeding and concomitant MVD increases the mortality risk in patients undergoing TAVR.
METHODS: A comprehensive literature review was conducted using PubMed, Embase, Google Scholar, ClinicalTrials.gov, Scopus, and OVID for studies until March 20, 2023. Using the random-effects Mantel-Haenszel method, we calculated pooled risk ratios (RRs) and their corresponding 95 % confidence intervals (CIs) for all dichotomous variables.
RESULTS: Six studies comprising 5822 patients (2541 with MAC [severe MAC (>4 mm thickness) 583; non-severe MAC 1958; 400 with MVD; and 1071 without MVD], 3281 without MAC) met inclusion criteria. At 30 days and 1 year, no significant differences were observed between the overall MAC and no MAC groups in terms of mortality, stroke, and permanent pacemaker implantation. However, MAC with MVD was associated with a higher risk of all-cause mortality compared to MAC without MVD at 30 days (RR = 3.43, 95 % CI 2.04-5.76, P < 0.00001) and at 1 year (RR = 2.44, 95 % CI 1.85-3.20, P < 0.00001). Moreover, the risk of cardiovascular mortality was higher in patients with MAC and MVD compared to those with MAC alone (RR = 2.77, 95 % CI 1.89-4.06, P < 0.00001). Additionally, patients with severe MAC had a higher risk of major bleeding at 30 days compared to the non-severe MAC group (RR = 1.33, 95 % CI 1.04-1.69, P = 0.02).
CONCLUSIONS: TAVR appears to be safe in patients with non-severe MAC, but severe MAC is associated with a higher risk of major bleeding and concomitant MVD increases the mortality risk in patients undergoing TAVR.
摘要：
背景：钙化性主动脉瓣狭窄是经导管主动脉瓣置换术（TAVR）的主要指征。在接受TAVR的患者中通常存在合并症二尖瓣环钙化（MAC）。关于MAC对TAVR结果的影响的数据有限。我们进行了系统评价和荟萃分析，以探讨MAC和伴随的二尖瓣功能障碍（MVD）对TAVR结局的影响。
方法：使用PubMed进行了全面的文献综述，Embase,谷歌学者，ClinicalTrials.gov,Scopus,和OVID的研究，直到2023年3月20日。使用随机效应Mantel-Haenszel方法，我们计算了所有二分变量的合并风险比(RR)及其相应的95%置信区间(CI).
结果：六项研究，包括5822例患者（2541例MAC[重度MAC（厚度>4毫米）583；非重度MAC1958；400例MVD；1071例无MVD]，3281没有MAC)符合纳入标准。在30天和1年，在死亡率方面，总体MAC组和无MAC组之间没有观察到显著差异，中风,和永久性起搏器植入。然而,与无MVD的MAC相比，有MVD的MAC在30天（RR=3.43，95％CI2.04-5.76，P<0.00001）和1年（RR=2.44，95％CI1.85-3.20，P<0.00001）时，全因死亡率风险较高。此外，与单独使用MAC的患者相比,MAC和MVD患者的心血管死亡风险更高(RR=2.77,95%CI1.89-4.06,P<0.00001).此外,与非重度MAC组相比,重度MAC组患者在30日发生大出血的风险更高(RR=1.33,95%CI1.04~1.69,P=0.02).
结论：TAVR在非重度MAC患者中似乎是安全的，但严重的MAC与大出血风险较高相关,并且伴随MVD会增加接受TAVR的患者的死亡风险.
方法：使用PubMed进行了全面的文献综述，Embase,谷歌学者，ClinicalTrials.gov,Scopus,和OVID的研究，直到2023年3月20日。使用随机效应Mantel-Haenszel方法，我们计算了所有二分变量的合并风险比(RR)及其相应的95%置信区间(CI).
结果：六项研究，包括5822例患者（2541例MAC[重度MAC（厚度>4毫米）583；非重度MAC1958；400例MVD；1071例无MVD]，3281没有MAC)符合纳入标准。在30天和1年，在死亡率方面，总体MAC组和无MAC组之间没有观察到显著差异，中风,和永久性起搏器植入。然而,与无MVD的MAC相比，有MVD的MAC在30天（RR=3.43，95％CI2.04-5.76，P<0.00001）和1年（RR=2.44，95％CI1.85-3.20，P<0.00001）时，全因死亡率风险较高。此外，与单独使用MAC的患者相比,MAC和MVD患者的心血管死亡风险更高(RR=2.77,95%CI1.89-4.06,P<0.00001).此外,与非重度MAC组相比,重度MAC组患者在30日发生大出血的风险更高(RR=1.33,95%CI1.04~1.69,P=0.02).
结论：TAVR在非重度MAC患者中似乎是安全的，但严重的MAC与大出血风险较高相关,并且伴随MVD会增加接受TAVR的患者的死亡风险.
