Eur Heart J:TAVI与外科主动脉瓣置换术治疗症状性严重主动脉瓣狭窄的比较

2019-04-25 xiangting MedSci原创

与SAVR相比,无论基线手术风险和THV系统类型如何,TAVI都与2年的全因死亡率和卒中风险降低相关。

鉴于来自严重主动脉瓣狭窄低危患者随机对照试验(RCTs)的新证据,这项研究在整个手术风险患者谱内,比较了经导管主动脉瓣植入术(TAVI)vs.外科主动脉瓣置换术(SAVR)的整体安全性和疗效。

这项meta分析在PROSPERO进行了注册(CRD42016037273)。研究确定了在不同随访期严重主动脉瓣狭窄患者中比较TAVI与SAVR的RCTs。按照预定标准提取试验、患者、治疗和结局特征。主要结局是2年的全因死亡率,用于主要分析。纳入7项试验,这些试验将8020名参与者随机分配为TAVI(4014名患者)和SAVR(4006名患者)治疗。

TAVI组高危、中危和低危手术风险试验的联合平均STS评分分别为9.4%、5.1%和2.0%。与SAVR相比,经导管主动脉瓣植入与全因死亡率明显降低相关{风险比[HR] 0.88[95%置信区间(CI)0.78-0.99],P=0.030};这种效应在整个手术风险谱内是一致的(P-相互作用=0.410)并且与经导管心脏瓣膜(THV)系统的类型无关(P-相互作用=0.674)。经导管主动脉瓣植入术可降低卒中风险[HR 0.81(95%CI 0.68-0.98),P=0.028]。与TAVI相比,外科主动脉瓣置换术可降低主要血管并发症 [HR 1.99(95%CI 1.34-2.93),P=0.001]和永久起搏器植入的风险[HR 2.27(95%CI 1.47-3.64),P<0.001]。

与SAVR相比,无论基线手术风险和THV系统类型如何,TAVI都与2年的全因死亡率和卒中风险降低相关。

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    2020-02-17 yxch48
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topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357180, encodeId=8da5135e180ad, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367172, encodeId=5c5d136e172f1, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415509, encodeId=d9df141550995, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563091, encodeId=bdbe156309160, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576705, encodeId=9a7915e670541, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=365230, encodeId=996036523016, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Thu Apr 25 10:25:00 CST 2019, time=2019-04-25, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1952553, encodeId=d3de195255348, content=<a href='/topic/show?id=3d594291393' target=_blank style='color:#2F92EE;'>#外科主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42913, encryptionId=3d594291393, topicName=外科主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0357291, createdName=xiaoshitou, createdTime=Thu Feb 20 15:44:00 CST 2020, time=2020-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734618, encodeId=d8ae1e34618f8, content=<a href='/topic/show?id=ffcf2114849' target=_blank style='color:#2F92EE;'>#严重主动脉瓣狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21148, encryptionId=ffcf2114849, topicName=严重主动脉瓣狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54e533785577, createdName=lq0312, createdTime=Fri Nov 08 20:44:00 CST 2019, time=2019-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742601, encodeId=9f4e1e426011b, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Feb 17 22:44:00 CST 2020, time=2020-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332642, encodeId=0d2313326426c, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357180, encodeId=8da5135e180ad, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367172, encodeId=5c5d136e172f1, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415509, encodeId=d9df141550995, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563091, encodeId=bdbe156309160, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576705, encodeId=9a7915e670541, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=365230, encodeId=996036523016, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Thu Apr 25 10:25:00 CST 2019, time=2019-04-25, status=1, ipAttribution=)]
    2019-04-27 zhaojie88
  6. [GetPortalCommentsPageByObjectIdResponse(id=1952553, encodeId=d3de195255348, content=<a href='/topic/show?id=3d594291393' target=_blank style='color:#2F92EE;'>#外科主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42913, encryptionId=3d594291393, topicName=外科主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0357291, createdName=xiaoshitou, createdTime=Thu Feb 20 15:44:00 CST 2020, time=2020-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734618, encodeId=d8ae1e34618f8, content=<a href='/topic/show?id=ffcf2114849' target=_blank style='color:#2F92EE;'>#严重主动脉瓣狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21148, encryptionId=ffcf2114849, topicName=严重主动脉瓣狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54e533785577, createdName=lq0312, createdTime=Fri Nov 08 20:44:00 CST 2019, time=2019-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742601, encodeId=9f4e1e426011b, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Feb 17 22:44:00 CST 2020, time=2020-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332642, encodeId=0d2313326426c, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357180, encodeId=8da5135e180ad, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367172, encodeId=5c5d136e172f1, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415509, encodeId=d9df141550995, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563091, encodeId=bdbe156309160, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576705, encodeId=9a7915e670541, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=365230, encodeId=996036523016, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Thu Apr 25 10:25:00 CST 2019, time=2019-04-25, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1952553, encodeId=d3de195255348, content=<a href='/topic/show?id=3d594291393' target=_blank style='color:#2F92EE;'>#外科主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42913, encryptionId=3d594291393, topicName=外科主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0357291, createdName=xiaoshitou, createdTime=Thu Feb 20 15:44:00 CST 2020, time=2020-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734618, encodeId=d8ae1e34618f8, content=<a href='/topic/show?id=ffcf2114849' target=_blank style='color:#2F92EE;'>#严重主动脉瓣狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21148, encryptionId=ffcf2114849, topicName=严重主动脉瓣狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, 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encodeId=bdbe156309160, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Apr 27 00:44:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576705, encodeId=9a7915e670541, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, 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  8. 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    2019-04-27 slcumt
  9. 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    2019-04-25 smartxiuxiu

    0

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