主动脉根部手术中保留主动脉瓣对马方综合征患者早期和远期预后影响的荟萃分析  

Effect of native aortic valve sparing aortic root reconstruction surgery on short-and long-term prognosis in Marfan syndrome patients： a meta-analysis

作　　者：胡锐[1] 王志维[1] 胡小平[1] 吴红兵[1] 周桢[1] 

机构地区：[1]武汉大学人民医院心血管外科,430060

出　　处：《中华心血管病杂志》2014年第5期433-438,共6页Chinese Journal of Cardiology

摘　　要：目的 荟萃分析主动脉根部手术中保留自体主动脉瓣对马方综合征患者早期和远期预后的影响.方法 检索Pubmed、Embase、Cochrane图书馆、中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献数据库中比较马方综合征主动脉根部手术中保留与替换主动脉瓣疗效的研究.对纳入的文献进行Newcastle-Ottawa量表评分及偏倚分析,采用Revman 5.0软件对提取的数据进行荟萃分析.结果 纳入7项临床研究,共690例马方综合征患者.荟萃分析显示,与替换主动脉瓣比较,保留主动脉瓣根部手术具有较低的二次开胸率（RR =0.51,95％ CI：0.29～0.90,P ＜0.05）、栓塞事件发生率（RR =0.17,95％ CI：0.05～0.57,P ＜0.01）、感染性心内膜炎发生率（RR =0.31,95％ CI：0.11～0.94,P ＜0.05）和远期病死率（RR=0.37,95％ CI：0.18～0.74,P＜0.01）,而二次手术率差异无统计学意义（RR=1.07,95％ CI：0.35～3.27,P＞0.05）.结论 保留主动脉瓣的根部置换术能够有效改善马方综合征患者的早期和远期预后,是一种较好的手术方式.Objective This meta-analysis was performed to analyze the effect ot preserving the native aortic valve on short-and long-term prognosis post aortic root reconstruction surgery for patients with Marfan syndrome.Methods Database including Pubmed,Embase,Cochrane library,CNKI,Wanfang,VIP and CBM were searched to collect studies comparing clinical results of valve sparing surgery with composite valve graft surgery for patients with Marfan syndrome.Study quality was assessed by Newcastle-Ottawa Scale and publication bias was assessed by visual inspection of the funnel plot together with Egger test.Clinical outcomes data was extracted from the manuscripts and analyzed with Revman 5.0 supplied by Cochrane collaboration.Results Seven clinical trials with 690 patients were included.Meta-analysis demonstrated that valve sparing surgery was associated with a lower incidence of re-exploration（RR =0.51,95％ CI：0.29-0.90,P ＜ 0.05）,thromboembolism （RR =0.17,95 ％ CI：0.05-0.57,P ＜ 0.01）,endocarditis （RR =0.31,95 ％ CI：0.11-0.94,P ＜ 0.05） and significantly lower long-term death rate （RR =0.37,95 ％ CI：0.18-0.74,P ＜ 0.01）.Reoperation rate was similar between the two groups（RR =1.07,95％ CI：0.35-3.27,P ＞ 0.05）.Conclusion Valve sparing aortic root reconstruction surgery is a superior procedure to composite valve graft surgery in term of improving the short-and long-term prognosis for patients with Marfan syndrome.

关 键 词：马凡综合征 心脏外科手术 主动脉瓣 Meta分析 

分 类 号：R654.3[医药卫生—外科学]