■我们旨在对随机试验进行荟萃分析,比较严重主动脉瓣狭窄经导管主动脉瓣置换术(TAVR)与外科主动脉瓣置换术(SAVR)患者的长期结局。TAVR的短期疗效和安全性得到证实,但长期结果尚不清楚.
■我们纳入了在最长的随访中比较TAVR和SAVR的随机对照试验。主要终点是死亡或致残卒中。次要终点是全因死亡率,心脏死亡率,中风,起搏器植入,瓣膜血栓形成,瓣膜梯度,和中度至重度瓣周漏。该研究在PROSPERO(CRD42023481856)注册。
■纳入7项试验(N=7785名患者)。加权平均试验随访时间为5.76±0.073年。总的来说,TAVR与SAVR(HR,1.02;95%CI,0.93-1.11;P=.70)。死亡率风险相似。与SAVR相比,TAVR导致更高的起搏器植入和中重度瓣周漏。不同手术风险特征的结果是一致的。与SAVR相比,自我扩张TAVR具有较低的死亡或卒中风险(P交互作用=.06),瓣膜血栓形成(P相互作用=.06),和瓣膜梯度(P相互作用<.01),但起搏器植入率高于球囊扩张式TAVR(P相互作用<.01)。
■在严重的主动脉瓣狭窄中,TAVR的长期死亡率或致残卒中风险与SAVR相似,但是起搏器植入的风险更高,特别是自膨式阀门。与SAVR相比,与球囊扩张瓣膜相比,自扩张瓣膜在死亡或卒中风险和瓣膜血栓形成方面的相对降低更大.
UNASSIGNED: We aimed to perform a meta-analysis of randomized trials comparing long-term outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) for severe aortic stenosis. The short-term efficacy and safety of TAVR are proven, but long-term outcomes are unclear.
UNASSIGNED: We included randomized controlled trials comparing TAVR vs SAVR at the longest available follow-up. The primary end point was death or disabling stroke. Secondary end points were all-cause mortality, cardiac mortality, stroke, pacemaker implantation, valve thrombosis, valve gradients, and moderate-to-severe paravalvular leaks. The study is registered with PROSPERO (CRD42023481856).
UNASSIGNED: Seven trials (N = 7785 patients) were included. Weighted mean trial follow-up was 5.76 ± 0.073 years. Overall, no significant difference in death or disabling stroke was observed with TAVR vs SAVR (HR, 1.02; 95% CI, 0.93-1.11; P = .70). Mortality risks were similar. TAVR resulted in higher pacemaker implantation and moderate-to-severe paravalvular leaks compared to SAVR. Results were consistent across different surgical risk profiles. As compared to SAVR, self-expanding TAVR had lower death or stroke risk (P interaction = .06), valve thrombosis (P interaction = .06), and valve gradients (P interaction < .01) but higher pacemaker implantation rates than balloon-expandable TAVR (P interaction < .01).
UNASSIGNED: In severe aortic stenosis, the long-term mortality or disabling stroke risk of TAVR is similar to SAVR, but with higher risk of pacemaker implantation, especially with self-expanding valves. As compared with SAVR, the relative reduction in death or stroke risk and valve thrombosis was greater with self-expanding than with balloon-expandable valves.