超导管大动脉置换结果在患有高梯度与低射出分数低梯度严重大动脉狭窄的患者:随机对照试验的元分析
Asseel Al-Bayati1, Abdullah Alrifai2, Fahed Darmoch3
1University of California San Francisco, Fresno, CA, USA.
概括
通过导管的大动脉置换 (TAVR) 在严重的大动脉狭窄患者低流-低梯度 (LF-LG) 与高梯度 (HG) AS相比,死亡率更高. 然而,对于LF-LG AS.来说,TAVR仍然是一个比保守管理更好的选择.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 心脏门疾病 心脏门疾病
背景情况:
- 严重的大动脉狭窄 (AS) 带来了挑战,特别是在低流-低梯度 (LF-LG) 亚型中.
- 对于接受过导管大动脉置换 (TAVR) 的LF-LG AS患者的结果需要进一步定义.
- 将LF-LG AS和高梯度 (HG) AS之间的TAVR结果进行比较至关重要.
研究的目的:
- 系统地审查和比较LF-LG严重AS和HG严重AS患者的TAVR结果.
- 为了评估两组之间的死亡率,心肌梗塞 (MI) 和中风率.
主要方法:
- 在4个在线数据库中进行了系统的文献审查.
- 包括受控随机和非随机研究.
- 使用风险比率 (95%置信区间) 分析数据,使用希金斯I2指数测量异质性.
主要成果:
- 分析包括来自6项队列研究的4 380名患者 (955名LF-LG AS,3425名HG AS).
- 与LF-LG AS患者相比,HG AS患者的TAVR显示30天死亡率 (5.1%与7.4%) 和12个月心血管死亡率 (5.5%与10.4%) 显著降低.
- 在30天或12个月后,在HG和LF-LGAS患者之间没有观察到MI或中风率的显著差异.
结论:
- 与HG严重AS患者相比,接受TAVR的LF-LG严重AS患者的1年全因死亡率和1年心血管死亡率较高.
- 尽管死亡率较差,但TAVR在LF-LG AS中提供了优异的结果,与保守的医疗管理相比.
- 心脏团队的讨论和明智的患者决策对于优化LF-LG AS中的TAVR至关重要.
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