背景:主动脉瓣环(SAA)较小的患者进行主动脉瓣置换术的患者-假体不匹配(PPM)的风险增加,对结果产生不利影响。与外科主动脉瓣置换术(SAVR)相比,经导管主动脉瓣置换术(TAVR)在减轻PPM方面显示出希望。
方法:我们遵循PRISMA指南进行了系统评价和荟萃分析,以比较临床结果,死亡率,接受TAVR和SAVR的SAA患者之间的PPM。通过全面的文献检索确定合格的研究,并评估质量和相关性。
结果:纳入9项研究,共2476名患者。TAVR表现出相似的30天和2年死亡率,心肌梗塞,与SAVR相比,中风率。然而,TAVR在降低SAVR后的中度生存率方面显示出显著优势,在延长的随访期间,观察到的血流动力学结果可能导致TAVR和SAVR之间的显著生存差异22此外,以前的研究发现,TAVR和SAVR的30天和2年死亡率相当,环大小无显著差异22,2330天和2年时卒中和心肌梗死的发生率以及严重PPM和大出血的发生率降低。相反,SAVR在30天永久性起搏器植入中具有更好的结果。两种干预措施的超声心动图结果具有可比性。
结论:我们的研究结果表明,TAVR和SAVR都是治疗主动脉瓣环小的AS患者的可行选择。TAVR在减少PPM和大出血方面具有优势,而SAVR在起搏器植入方面表现更好。未来的研究应该集中在比较新一代TAVR技术和设备与SAVR。考虑患者特征对于选择AS的最佳治疗方法至关重要。
BACKGROUND: Patients with a small aortic annulus (SAA) undergoing aortic valve replacement are at increased risk of patient-prosthesis mismatch (PPM), which adversely affects outcomes. Transcatheter aortic valve replacement (TAVR) has shown promise in mitigating PPM compared to surgical aortic valve replacement (SAVR).
METHODS: We conducted a systematic
review and meta-analysis following PRISMA guidelines to compare clinical outcomes, mortality, and PPM between SAA patients undergoing TAVR and SAVR. Eligible studies were identified through comprehensive literature searches and assessed for quality and relevance.
RESULTS: Nine studies with a total of 2476 patients were included. There was no significant difference in 30-day Mortality between TAVR vs SAVR groups (OR = 0.65, 95% CI [ 0.09-4.61], P = 0.22). There was no difference between both groups regarding myocardial infarction at 30 days (OR = 0.63, 95% CI [0.1-3.89], P = 0.62). TAVR was associated with a significantly lower 30-day major bleeding and 2-year major bleeding, Pooled studies were homogeneous (OR = 0.44, 95% CI [0.31-0.64], P < 0.01, I2 = 0, P = 0.89), (OR = 0.4 ,95% CI [0.21-0.77], P = 0.03, I2 = 0%, P = 0.62) respectively. TAVR was associated with a lower rate of moderate PPM (OR = 0.6, 95% CI [ 0.44-0.84], p value = 0.01, i2 = 0%, p value = 0.44). The overall effect estimate did not favor any of the two groups regarding short-term Mild AR (OR = 5.44, 95% CI [1.02-28.91], P = 0.05) and Moderate/severe AR (OR = 4.08, 95% CI [ 0.79-21.02], P = 0.08, I2 = 0%, P = 0.59).
CONCLUSIONS: Our findings suggest that both TAVR and SAVR are viable options for treating AS in patients with a small aortic annulus. TAVR offers advantages in reducing PPM and major bleeding, while SAVR performs better in terms of pacemaker implantation. Future studies should focus on comparing newer generation TAVR techniques and devices with SAVR. Consideration of patient characteristics is crucial in selecting the optimal treatment approach for AS.