马方综合征患者行Bentall或保留主动脉瓣的主动脉根部置换术中远期疗效的荟萃分析  

The mid-term or long-term results of Bentall and aortic valve-sparing root replacement in Marfan syndrome: a systematic review and Meta-analysis

作　　者：李建荣[1] 许尚栋[1] 潘旭东[1] 阳晟[1] 高峰[1] 李庆[1] 董松波[1] 郑军[1] 孙立忠[1] CHEN Yu 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所北京市大血管外科置入式人工材料工程技术研究中心心外科5病房,100029

出　　处：《心肺血管病杂志》2016年第9期748-752,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：重点医学专业发展"扬帆"计划(批准编号ZYLX201503);国家卫生和计划生育委员会公益性行业科研专项项目:国人主动脉夹层规范化诊疗及关键技术的研究(批准编号201402009)资金资助项目

摘　　要：目的:系统回顾和荟萃分析比较马方综合征患者行Bentall或保留主动脉瓣的主动脉根部置换术的中远期疗效。方法:1.检索的目标数据库包括PUBMED、EMBASE、the Cochrane Librar。检索词确定为:marfan,david和valve sparing。文献语言限定为英文和中文。2.纳入标准:(1)两组马方综合征患者分别接受Bentall或保留主动脉瓣的主动脉根部置换术,每组病例数均≥10;(2)前瞻性或回顾性队列研究,须满足非随机研究方法组制定的队列研究特征;(3)随访时间≥1年。3.结局测定:主动脉根部再次手术、感染性心内膜炎、颅内出血或血栓、综合瓣膜相关事件等发生情况。结果:共检索226篇文献,12篇文献纳入本次荟萃分析。与Bentall手术相比,保留主动脉瓣的主动脉根部置换手术发生感染性心内膜炎(0.09%/年vs.0.59%/年,P=0.01)和颅内出血或血栓(0.28%/年vs.0.71%/年,P=0.01)的风险较低,再植法发生感染性心内膜炎(0.06%/年vs.0.61%/年,P=0.02)、颅内出血或血栓(0.38%/年vs.0.75%/年,P=0.04)、综合瓣膜相关事件(1.15%/年vs.1.85%/年,P=0.002)的风险较低。其他结局指标两组之间无差别。结论:马方综合征患者行保留主动脉瓣的主动脉根部置换术,特别是再植法,其中远期疗效优于Bentall手术。Objective：To undertake a systematic review and meta-analysis of cohort studies to compare the mid-term or long-term postoperative results of aortic valve-sparing root replacement and Bentall procedure in patients with Marfan syndrome. Methods： A comprehensive search strategy was run in PUBMED, EMBASE, the Cochrane Library and Chinese Biomedical Literature Database. There were no restrictions on publication year or type of publication. Two researchers independently performed the literature search, data extraction and quality assessment. Inclusion criteria were： （1） two cohorts of patients with MFS received aortic valve-sparing root replacement and Bentall procedure respectively and study size n ≥ 10; （2） prospective or retrospective cohort study is eligible ; （3） the duration of follow up was not less than 1 year. Outcome events were ： reoperation on the aortic root, endocarditis, intracerebral bleeding and thromboembolic event, and composite valve-related event. Results： 12 studies were included in this meta-analysis. Compared with Bentall, aortic valve-sparing root re- placement was associated with lower rates of endocarditis （0. 09%/year vs. 0. 59%/year, P = 0.01 ） and intracerebral bleeding and thromboembolic event （0. 28%/year vs. O. 71%/year, P = 0. 01 ）. Compared with Bentall, reimplantation was associated with lower rates of endocarditis （0. 06%/year vs. 0. 61%/year, P = 0. 02） , intracerebral bleeding and thromboembolic event （0. 38%/year vs. 0. 75%/year, P = 0. 04 ）, and composite valve-related event （ 1.15 %/year vs. 1.85 %/year, P = 0. 002）. Conclusions ： Aortic valve-sparing root replacement, especially reimplantation, should be a better surgical option for patients with Marfan syn- drome presenting with aneurysms of the aortic root.

关 键 词：马方综合征 主动脉根部 心脏外科手术 荟萃分析 

分 类 号：R54[医药卫生—心血管疾病]