跨导管大动脉置换严重大动脉狭窄的血液动力学亚型:一个网络的元分析
Waqas Ullah1, Muhammad Khawar Sana2, Maryam Mukhtar3
1Department of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
概括
通过导管的大动脉置换 (TAVR) 对于严重的大动脉狭窄 (AS) 在血液动力学亚型中有效. 经典的低流量,低梯度AS患者在TAVR后面临更高的MACE风险,而不是高梯度AS患者.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 严重的大动脉狭窄 (AS) 呈现出多种血液动力学亚型,包括高梯度AS (HGAS),经典的低流,低梯度AS (LFLG) 和矛盾的低流,低梯度AS (pLFLG).
- 在这些AS亚型中,通过导管的大动脉置换 (TAVR) 的结果仍然不完全理解,现有的研究显示出混合的结果.
- 了解亚型特异性结果对于优化TAVR患者选择和管理至关重要.
研究的目的:
- 为了比较不同血液动力学亚型的严重AS患者的TAVR结果:HGAS,经典LFLG和PLFLG.
- 评估这些患者群体中TAVR后主要不良心血管事件 (MACE) 和周围程序并发症的发生率.
- 根据AS血动力学分类,提供基于证据的关于TAVR的安全性和有效性的见解.
主要方法:
- 在PubMed,Embase和Cochrane数据库中进行了系统的文献搜索,直到2023年9月.
- 包括观察性研究,比较HGAS,经典LFLG和PLFLG患者的TAVR结局.
- 使用双变量,影响力和频率模型进行了网络元分析,以确定初级 (MACE) 和二级结果的净赔率比率 (OR) 和95%置信区间 (CI).
主要成果:
- 该分析包括21项研究,涉及17298名患者 (8,556名HGAS,8,742名LFLG/pLFLG).
- 在所有AS亚型中,TAVR有效地降低了大动脉梯度并增加了大动脉膜面积.
- 与HGAS相比,经典的LFLG AS患者的MACE (OR,1.68) 和死亡风险 (术后,1个月,12个月) 显著更高,而pLFLG患者的MACE率 (OR,0.98) 与HGAS相似.
- 在LFLG (OR,3.57) 中,手术的需要更高. 两组之间没有观察到心脏病发作,出血,血管并发症,准膜泄漏或心脏起器植入的显著差异.
结论:
- TAVR是严重AS的可行的治疗方法,无论血液动力学亚型如何.
- 患有经典LFLG AS的患者经历了MACE的更高风险,主要是由于死亡率增加,TAVR后与HGAS相比.
- 矛盾的LFLGAS患者表现出与HGAS患者相比的MACE风险,周围手术并发症没有显著增加.
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