摘要
目的比较二叶式主动脉瓣狭窄(BAV)和三叶式主动脉瓣狭窄(TAV)经导管主动脉瓣置换术(TAVR)治疗的临床疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、中国生物医学文献数据库、中国知网和万方数据库,检索时限均为从建库至2019年3月。由2名评价员独立筛选文献、提取资料和评价纳入研究的质量,采用RevMan 5.3和Stata 15.0软件进行Meta分析。结果最终纳入15项队列研究,共计45770例患者,其中BAV患者1500例,TAV患者44270例。两组患者在术后院内死亡率[OR=1.29,95%CI(0.91,1.83),P=0.15]、30 d死亡率[OR=1.23,95%CI(0.86,1.77),P=0.25]、1年死亡率[OR=1.14,95%CI(0.87,1.50),P=0.33]方面差异无统计学意义。BAV组患者在手术成功率[OR=0.57,95%CI(0.44,0.74),P<0.01]、术后出血事件[OR=0.72,95%CI(0.58,0.91),P<0.01]和术后血管损伤[OR=0.68,95%CI(0.47,0.97),P=0.03]方面均低于TAV组患者,且差异有统计学意义。BAV组患者的瓣周漏发生率高于TAV组患者[OR=1.47,95%CI(1.13,1.90),P<0.01]。在中转开胸、术后心肌梗死、肾功能衰竭、神经事件、跨瓣压差和起搏器植入方面,两组患者差异无统计学意义。结论与TAV相比,TAVR在BAV患者中应用是可行有效的。
Objective To compare the clinical outcomes of bicuspid aortic valve stenosis(BAV)and tricuspid aortic valve stenosis(TAV)after transcatheter aortic valve replacement(TAVR).Methods A computer-based search in PubMed,EMbase,The Cochrane Library,CBM,CNKI and Wanfang databases from their date of inception to March 2019 was conducted.Two reviewers independently screened the articles,extracted data and evaluated their quality.RevMan 5.3 and Stata 15.0 softwares were used for meta-analysis.Results The selected 15 cohort studies contained 45770 patients,including 1500 of BAV patients and 44270 of TAV patients.The results showed that no statistical difference was found in postoperative in-hospital mortality[OR=1.29,95%CI(0.91,1.83),P=0.15],30-day mortality[OR=1.23,95%CI(0.86,1.77),P=0.25],and 1-year mortality[OR=1.14,95%CI(0.87,1.50),P=0.33]between the two groups.The surgical success rate[OR=0.57,95%CI(0.44,0.74),P<0.01],postoperative bleeding events[OR=0.72,95%CI(0.58,0.91),P<0.01]and postoperative vascular injury[OR=0.68,95%CI(0.47,0.97),P=0.03]of patients in the BAV group were lower than those in the TAV group.The incidence of paravalvular leak in the BAV group was higher than that in the TAV group[OR=1.47,95%CI(1.13,1.90),P<0.01].No significant difference was found between the two groups in terms of conversion to surgery,postoperative myocardial infarction,postoperative renal failure,postoperative neurologic events,postoperative valve gradient difference and pacemaker implantation.Conclusion Compared with TAV,the application of TAVR in BAV patients is feasible and effective.
作者
刘世栋
董帅
方涛
雷想
宋兵
LIU Shidong;DONG Shuai;FANG Tao;LEI Xiang;SONG Bing(The First Clinical Medical College of Lanzhou University,Lanzhou,730000,P.R.China;Department of Cardiovascular Surgery,The First Hospital of Lanzhou University,Lanzhou,730000,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2020年第6期693-699,共7页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
甘肃省青年科技计划项目(1506RJYA264)。
