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.
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.