成形还是置换?关于孤立性三尖瓣术式疗效的meta分析  

Repair versus replacement:a meta-analysis on the efficacy of isolated tricuspid valve surgery

作　　者：李誉 尚倩 卢佳佳[1] Li Yu;Shang Qian;Lu Jiajia(Department of Cardiac Surgery,Wuhan Asian Heart Hospital,Wuhan 430022,China)

机构地区：[1]武汉亚洲心脏病医院心脏外科,武汉430022

出　　处：《中华胸心血管外科杂志》2022年第6期321-326,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的分析孤立性三尖瓣手术术式的疗效,以期为临床决策提供依据。方法计算机检索PubMed、EMbase、the Cochrane Library、Web of Science以及中国知网、维普中文科技期刊全文数据库和万方数据库,收集从建库至2021年9月30日的所有孤立性三尖瓣手术的研究,由2名研究者独立阅读符合纳入和排除标准的文献,进行文献筛选、资料提取以及文献质量评价,采用RevMan 5.3软件进行meta分析。结果共纳入18项病例对照研究结果,共10023例患者,其中三尖瓣成形组(TVP组)4749例、三尖瓣置换组(TVR组)5274例。Meta分析结果显示,孤立性三尖瓣成形及置换的合并院内病死率分别为8.4%对9.9%,OR=0.64(0.44,0.93);随访3个月以上病死率13.9%对16.1%,OR=0.91(0.49,1.69);起搏器置入率7.9%对26.4%,OR=0.24(0.21,0.30);院内卒中率14.4%对10.3%,OR=1.41(0.98,2.04);院内肾衰竭率12.4%对15.6%,OR=0.81(0.72,0.92)。结论与三尖瓣置换相比,孤立性三尖瓣修复术与更低的院内病死率、肾功能衰竭和起搏器置入术相关,远期病死率及院内卒中率差异无统计学意义,因此在二者均可作为选择的情况下,推荐三尖瓣修复术。Objective We performed a meta-analysis examining outcomes of isolated tricuspid valve repair versus replacement.Methods We searched PubMed,Embase,the Cochrane Library,Web of Science,CNKI,VIP database and WanFang database from the inception to September 30,2021 for studies reporting outcomes of both isolated tricuspid valve repair and replacement,excluding congenital tricuspid aetiologies.Data were extracted and pooled using random-effects models and Review Manager 5.3 software.Results A total of 18 articles were included,covering 10023 patients,totalling 4749 repairs and 5274 replacements.Pooled operative mortality rates and odds ratios(95%confidence intervals)for isolated tricuspid repair and replacement surgery were 8.4%vs.9.9%,OR=0.64(0.44,0.93).Tricuspid repair was also associated with lower in-hospital acute renal failure 12.4%vs.15.6%,OR=0.81(0.72,0.92)and pacemaker implantation 7.9%vs.26.4%,OR=0.24(0.21,0.30).There were no differences in rates of hospital stroke 14.4%vs.10.3%,OR=1.41(0.98,2.04)and late mortality rates 13.9%vs.16.1%,OR=0.91(0.49,1.69).Conclusion Isolated tricuspid valve repair is associated with significantly reduced in-hospital mortality,renal failure and pacemaker implantation compared with replacement and is therefore recommended where feasible for isolated tricuspid valve disease.

关 键 词：孤立性三尖瓣手术 三尖瓣成形 三尖瓣置换 荟萃分析 

分 类 号：R654.2[医药卫生—外科学]