Efficacy of transcatheter aortic vavle repalcement and surgical aortic vavle replacement for aortic stenosis: a Meta analysis

doi:10.3969/j.issn.2095-4344.1411

Abstract

Abstract:

BACKGROUND: Transcatheter aortic vavle replacement and surgical aortic vavle replacement are the main treatment for aortic stenosis. However, the efficacy and prognosis between the two methods were still inconsistent.

OBJECTIVE: To investigate the efficacy and prognosis of transcatheter aortic vavle repalcement and surgical aortic vavle replacement in the treatment of aortic stenosis with evidence-based medicine.

METHODS: We searched relevant literature from Chinese and English databases such as EMbase, Medline, PubMed, and VIP to retrieve randomized controlled trial studies. Data were analyzed by Revman 5.0 to compare short-term (30 days) and long-term (1 year) mortality, incidence of stroke, incidence of myocardial infarction, incidence of hemorrhage, incidence of renal damage and rate of pacemaker implantation.

RESULTS AND CONCLUSION: Eight randomized controlled trials involving 6 147 patients were included in the final analysis. Among these patients, 3 136 patients received transcatheter aortic valve replacement (study group) and 3 011 patients underwent surgical aortic valve replacement (control group). There were no significant differences in mortality, incidence of stroke, incidence of myocardial infarction, and incidence of hemorrhage between study and control groups at 30 days post-surgery [OR=0.92, 95%CI (0.74, 1.13), Z=0.83, P > 0.05; OR=0.82, 95%CI (0.49, 1.38), Z=0.74, P > 0.05; OR=0.63, 95%CI (0.38, 1.05), Z=1.77, P > 0.05; OR=0.50, 95%CI (0.20, 1.26), Z=1.47, P > 0.05]. At 30 days post-surgery, the incidence of renal damage in the study group was significantly lower than that in the control group [OR=0.43, 95%CI (0.33, 0.57), Z=5.89, P < 0.01], the rate of pacemaker implantation was significantly higher in the study group was significantly higher than that in the control group [OR=4.77, 95%CI (1.36, 16.72), Z=2.94, P < 0.01]. There were no significant differences in mortality, incidence of stroke, and incidence of myocardial infarction at 1 year post-surgery between study and control groups [OR=0.93, 95%CI (0.81, 1.07), Z=1.02, P > 0.05; OR=1.00, 95%CI (0.81, 1.23), Z=0.02, P > 0.05; OR=0.88, 95%CI (0.61, 1.28), Z = 0.65, P > 0.05]. At 1 year post-surgery, the rate of pacemaker implantation in the study group was significantly higher than that in the control group [OR=3.47, 95%CI (1.64, 7.34), Z=3.26, P < 0.01]. The results showed that the efficacy and prognosis of the two methods for the treatment of aortic stenosis were comparable, but the transcatheter aortic valve replacement treatment had less trauma and a higher rate of pacemaker implantation than the aortic valve replacement.

Key words: valve replacement, aortic stenosis, transcatheter aortic valve replacement, surgical aortic valve replacement, randomized controlled study, catheter, meta-analysis

CLC Number:

Yin Peiyong, Cui Xiaohong, Xiong Ting, Li Sufang, He Ximin. Efficacy of transcatheter aortic vavle repalcement and surgical aortic vavle replacement for aortic stenosis: a Meta analysis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(30): 4905-4912.

Figures/Tables 5

2.2 结果分析 2.2.1 术后30 d短期结局主要结局：①5篇文章报道了经导管主动脉瓣置换和外科主动脉瓣置换治疗主动脉瓣狭窄的死亡率[5-6，8，10-11]，各研究间无异质性(卡方检验值Chi2=2.27，自由度df=4，P=0.69，I2=0%)，因此应用固定效应模型。Meta分析结果显示两组死亡率无明显差异[OR=0.92，95%CI(0.74，1.13)，Z=0.83，P=0.40]，见图2a；②6篇文章报道了经导管主动脉瓣置换和外科主动脉瓣置换治疗脑卒中的发生率[5-6，8-9，10-11]，各研究间异质性有明显差异(卡方检验值Chi2=13.94，自由度df=5，P=0.02，I2=64%)，因此采用随机效应模型。Meta分析结果显示两组术后脑卒中发生率无明显差异[OR=0.82，95%CI(0.49，1.38)，Z=0.74，P=0.46]，见图2b。亚组分析的结果也未见明显差异。次要结局：①4篇文章报道了经导管主动脉瓣置换和外科主动脉瓣置换术后心肌梗死发生率[5-6，10-11]，各研究间异质性未见明显差异(卡方检验值Chi2=1.4，自由度df=3，P=0.70，I2=0%)，因此采用固定效应模型。Meta分析结果显示两组术后心肌梗死发生率无明显差异[OR=0.63，95%CI(0.38，1.05)，Z=1.77，P=0.08]，见图2c；②6篇文章报道了经导管主动脉瓣置换和外科主动脉瓣置换术后出血发生率[5-6，8-11]，各研究间异质性可见明显差异(卡方检验值Chi2=157.43，自由度df=5，P < 0.001，I2=97%)，因此采用随机效应模型。Meta分析结果显示两组术后心肌梗死发生率无明显差异[OR=0.50，95%CI(0.20，1.26)，Z=1.47，P=0.14]，见图2d；③6篇文章报道了经导管主动脉瓣置换和外科主动脉瓣置换术后肾损伤发生率[5-6，8-11]，各研究间异质性未见明显差异(卡方检验值Chi2=7.23，自由度df=5，P=0.20，I2=31%)，因此采用固定效应模型。Meta分析结果显示研究组术后肾损伤发生率明显低于对照组[OR=0.43，95%CI(0.33，0.57)，Z=5.89，P < 0.001]，见图2e；④6篇文章报道了经导管主动脉瓣置换和外科主动脉瓣置换术后起搏器植入率[5-6，8-11]，各研究间异质性可见明显差异(卡方检验值Chi2=49.39，自由度df=2，P < 0.01，I2=90%)，因此采用随机效应模型。Meta分析结果显示研究组起搏器植入率明显高于对照组[OR=3.08，95%CI(1.46，6.50)，Z=2.44，P < 0.001]，见图2f。"

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