MitraClip与二次腹外科手术:一个系统性审查和更新的元分析
Juan Pinilla1, Sebastian Jaramillo2, Mariano Gallo Ruelas3
1CES University, School of Medicine, Medellín, Colombia.
概括
与手术相比,MitraClip跨导管边缘修复 (M-TEER) 对于二次腹 (MR) 有效地减少了残留的MR. 然而,这并没有显著改善死亡率或心力衰竭住院情况.
科学领域:
- 心脏病学
- 干预心脏病学
- 心脏外科
背景情况:
- 对于二次腹的最佳治疗方法有争议,有手术和皮肤穿的选择.
- 需要进行进一步的比较分析.
研究的目的:
- 通过MitraClip进行皮肤透过导管边缘修复 (M-TEER) 与二次MR手术的疗效和安全性进行比较.
- 评估M-TEER和手术方法之间的临床结果和残留MR率.
主要方法:
- 在PubMed,Embase和Cochrane数据库进行系统的文献搜索.
- 包括11项研究 (2项RCT,9项观察性) 涉及1605名接受M-TEER (MitraClip) 或二次MR手术的患者.
- 使用随机效应模型的95%置信区间 (CI) 的风险比率 (RR) 的元分析.
主要成果:
- 与手术相比,使用MitraClip的M- TEER显示残留MR等级≤2+的比率显著降低 (RR:0.86,95%CI:0.78至0.95).
- 在全因死亡率 (RR: 1.18,95% CI: 0. 93至1. 49),心血管死亡率 (RR: 1.42,95% CI: 0. 54至3. 68) 或心力衰竭住院率 (RR: 1.55,95% CI: 0. 79至3. 04) 中没有发现显著差异.
- 功能状态 (NYHA I/ II类) 也没有显著的群体差异 (RR: 0. 92, 95% CI: 0. 83至1. 01).
结论:
- 与二次性MR患者的手术相比,MitraClip M- TEER与残留MR的发生率较低.
- 与手术相比,尽管残留MR减少,但M-TEER在死亡率,心力衰竭住院或功能状态方面没有表现出更好的临床结果.
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