Abstract：
BACKGROUND: Aortic valve stenosis is a common cardiac condition that requires intervention for symptomatic and/or prognostic reasons. The two most common interventions are surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). The ratio of TAVI:SAVR has increased twofold over the past few years and is now being considered in intermediate-risk patients as well. One of the significant benefits of TAVI is that it is less invasive; however, one of the drawbacks is a high paravalvular leaks (PVLs) rate compared to SAVR. To assess the impact of PVLs on survival, progression of heart failure, and the need for re-intervention.
METHODS: We conducted a comprehensive systematic literature search from the conception of TAVI 2002 until December 2022 through Embase (Ovid), MEDLINE (Ovid), Science Direct, and CENTRAL (Wiley). We followed PRISMA guidelines and checklists. Review protocol registration ID in PROSPERO: CRD42023393742.
RESULTS: We identified 28 studies that met our eligibility criteria, and only 24 studies were suitable for pooling in a meta-analysis (including their hazard ratio with a confidence interval of 95%) assessing our primary outcome (all-cause mortality). The remaining four studies were narratively synthesised. RevMan V5.4 (Version 5.4. Cochrane Collaboration, 2020) was utilised to pool meta-analysis data to assess effect estimates of PVLs in both intervention arms, using a random effect model for calculation (hazard ratio 1.14 confidence interval 95% 1.08-1.21 [p<0.0001]), with a follow-up duration between 30 days to 5 years.
CONCLUSIONS: Patients with mild or higher degrees of PVLs in both intervention arms incurred unfavourable outcomes. The incidence of PVLs was significantly higher with TAVI; even a mild degree led to poor quality of life and increased all-cause mortality on long-term follow-up.
METHODS: We conducted a comprehensive systematic literature search from the conception of TAVI 2002 until December 2022 through Embase (Ovid), MEDLINE (Ovid), Science Direct, and CENTRAL (Wiley). We followed PRISMA guidelines and checklists. Review protocol registration ID in PROSPERO: CRD42023393742.
RESULTS: We identified 28 studies that met our eligibility criteria, and only 24 studies were suitable for pooling in a meta-analysis (including their hazard ratio with a confidence interval of 95%) assessing our primary outcome (all-cause mortality). The remaining four studies were narratively synthesised. RevMan V5.4 (Version 5.4. Cochrane Collaboration, 2020) was utilised to pool meta-analysis data to assess effect estimates of PVLs in both intervention arms, using a random effect model for calculation (hazard ratio 1.14 confidence interval 95% 1.08-1.21 [p<0.0001]), with a follow-up duration between 30 days to 5 years.
CONCLUSIONS: Patients with mild or higher degrees of PVLs in both intervention arms incurred unfavourable outcomes. The incidence of PVLs was significantly higher with TAVI; even a mild degree led to poor quality of life and increased all-cause mortality on long-term follow-up.
摘要：
背景：主动脉瓣狭窄是一种常见的心脏疾病，需要出于症状和/或预后原因进行干预。两种最常见的干预措施是外科主动脉瓣置换术（SAVR）和经导管主动脉瓣植入（TAVI）。在过去的几年中，TAVI：SAVR的比率增加了两倍，现在也被考虑在中危患者中。TAVI的显著好处之一是它的侵入性较小；然而，与SAVR相比,缺点之一是高的瓣周漏(PVL)率。为了评估PVL对生存率的影响，心力衰竭的进展，以及重新干预的必要性。
方法：我们从TAVI2002的概念到2022年12月通过Embase（Ovid）进行了全面的系统文献检索，MEDLINE(Ovid),科学直接，和中央（威利）。我们遵循PRISMA指南和清单。查看PROSPERO中的协议注册ID：CRD42023393742。
结果：我们确定了28项符合我们资格标准的研究，只有24项研究适合纳入评估我们主要结局(全因死亡率)的荟萃分析(包括其风险比,置信区间为95%).其余四项研究是叙述综合的。RevManV5.4（版本5.4。Cochrane协作,2020)用于汇集荟萃分析数据，以评估两个干预组中PVL的效果估计，使用随机效应模型进行计算(风险比1.14置信区间95%1.08-1.21[p<0.0001])，随访时间在30天至5年之间。
结论：在两个干预组患有轻度或更高程度PVL的患者出现了不利的结果。TAVI组PVL的发生率明显较高；即使轻度也会导致生活质量差，并在长期随访中增加全因死亡率。
方法：我们从TAVI2002的概念到2022年12月通过Embase（Ovid）进行了全面的系统文献检索，MEDLINE(Ovid),科学直接，和中央（威利）。我们遵循PRISMA指南和清单。查看PROSPERO中的协议注册ID：CRD42023393742。
结果：我们确定了28项符合我们资格标准的研究，只有24项研究适合纳入评估我们主要结局(全因死亡率)的荟萃分析(包括其风险比,置信区间为95%).其余四项研究是叙述综合的。RevManV5.4（版本5.4。Cochrane协作,2020)用于汇集荟萃分析数据，以评估两个干预组中PVL的效果估计，使用随机效应模型进行计算(风险比1.14置信区间95%1.08-1.21[p<0.0001])，随访时间在30天至5年之间。
结论：在两个干预组患有轻度或更高程度PVL的患者出现了不利的结果。TAVI组PVL的发生率明显较高；即使轻度也会导致生活质量差，并在长期随访中增加全因死亡率。
