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首页> 外文期刊>The American Journal of Cardiology >Meta-Analysis of Transcatheter Versus Surgical Aortic Valve Replacement in Low Surgical Risk Patients
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Meta-Analysis of Transcatheter Versus Surgical Aortic Valve Replacement in Low Surgical Risk Patients

机译：经转截管的荟萃分析与低手术风险患者的外科主动脉瓣膜置换

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Current guidelines recommend transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis at elevated surgical risk, but not for patients at low surgical risk. Our objective is to compare major clinical outcomes and procedural complications with TAVI versus surgical aortic valve replacement in patients with severe aortic stenosis at low surgical risk. We conducted a systematic review and meta-analysis of randomized controlled trials, identified through a systematic search of the MEDLINE, Embase, and Cochrane databases. Count data were pooled across trials using random-effects models with inverse variance weighting to obtain relative risks (RRs) and corresponding 95% confidence intervals (CIs). Three randomized controlled trials (n = 2,629) were included. At 30 days, TAVI was associated with a substantial reduction in all-cause mortality (RR: 0.45, 95% CI: 0.20 to 0.99), atrial fibrillation (RR: 0.27, 95% CI: 0.17 to 0.41), life threatening/disabling bleeding (RR: 0.29, 95% CI: 0.12 to 0.69), and acute kidney injury (RR: 0.28, 95 % CI: 0.14 to 0.57). The reduction in atrial fibrillation persisted at 12 months (RR: 0.32, 95% CI: 0.21 to 0.49). However, TAVI patients had an increased risk of permanent pacemaker implantation at both 30 days (RR: 3.13, 95% CI: 1.36 to 7.21) and 12 months (RR: 2.99, 95% CI: 1.19 to 7.51). Due to the low absolute numbers of events, results were inconclusive at 30 days and 12 months for cardiovascular mortality, stroke, transient ischemic attack, and myocardial infarction. In conclusion, while some outcomes remained inconclusive, these data suggest that TAVI should be considered as a first-line therapy for the treatment of severe aortic stenosis in low surgical risk patients. (C) 2020 Elsevier Inc. All rights reserved.
机译：目前的指导方针推荐经截觉管主动脉瓣植入（TAVI），用于在升高的手术风险下严重主动脉狭窄的患者，但不适用于低手术风险的患者。我们的目的是比较Tavi的主要临床结果和程序并发症与患有低手术风险的严重主动脉狭窄患者的手术主动脉瓣膜置换。我们对随机对照试验进行了系统审查和荟萃分析，通过系统搜索了Medline，Embase和Cochrane数据库来确定。使用随机效应模型汇集计数数据，使用具有逆方差加权的随机效果模型来获得相对风险（RRS）和相应的95％置信区间（CIS）。包括三项随机对照试验（n = 2,629）。在30天内，TAVI与全因死亡率大幅减少有关（RR：0.45,95％CI：0.20至0.99），心房颤动（RR：0.27,95％CI：0.17至0.41），生命威胁/禁用出血（RR：0.29,95％CI：0.12至0.69），急性肾损伤（RR：0.28,95％CI：0.14至0.57）。心房颤动的降低在12个月内持续存在（RR：0.32,95％Ci：0.21至0.49）。然而，Tavi患者在30天内（RR：3.13,95％Ci：1.36至7.21）和12个月（RR：2.99,95％Ci：1.19至7.51），培养的永久起搏器植入风险增加。由于事件的绝对绝对低，结果在30天和12个月内为心血管死亡，中风，短暂性脑缺血发作和心肌梗塞的术语不确定。总之，虽然一些结果仍然不确定，但这些数据表明，Tavi应被视为治疗低外科患者严重主动脉狭窄的一线治疗。 （c）2020 Elsevier Inc.保留所有权利。

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