二叶式主动脉瓣患者经导管主动脉瓣置换术后新发传导异常预测因素的Meta分析  

Predictive factors of new-onset conduction abnormalities after transcatheter aortic valve replacement in patients with bicuspid aortic valve:a meta-analysis

作　　者：王丽岚 王伟敏 许巧如 王斌[1,2] WANG Lilan;WANG Weimin;XU Qiaoru;WANG Bin(Department of Emergency,Xiamen Cardiovascular Hospital Affiliated to Xiamen University,Xiamen 361005,P.R.China;Medical School of Xiamen University,Xiamen 361005,P.R.China)

机构地区：[1]厦门大学附属厦门心血管病医院急诊科,厦门361005 [2]厦门大学医学院,厦门361005

出　　处：《中国循证医学杂志》2023年第6期672-678,共7页Chinese Journal of Evidence-based Medicine

基　　金：厦门市联合支持医疗卫生重点项目(编号:3502Z20209006)。

摘　　要：目的系统评价二叶式主动脉瓣患者经导管主动脉瓣置换术后新发传导异常的预测因素。方法计算机检索CNKI、VIP、WanFang Data、PubMed、Cochrane Library和EMbase数据库,搜集二叶式主动脉瓣患者经导管主动脉瓣置换术后新发传导异常的相关研究,检索时限均为建库至2022年12月5日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入6个研究,包括758例二叶式主动脉瓣患者。Meta分析结果显示,年龄[MD=-1.48,95%CI(-2.73,-0.23),P=0.02]、慢性肾病[OR=0.14,95%CI(0.06,0.34),P<0.01]、术前左束支传导阻滞[OR=2.84,95%CI(1.11,7.23),P=0.03]、膜间隔长度[MD=0.93,95%CI(0.05,1.80),P=0.04]、植入深度[MD=-2.06,95%CI(-2.96,-1.16),P<0.001]、膜间隔长度与植入深度之差[MD=3.05,95%CI(1.92,4.18),P<0.01]、植入深度>膜间隔长度[OR=0.27,95%CI(0.15,0.49),P<0.01]都可能是新发传导异常的预测因素。结论当前有限证据表明,年龄、慢性肾病、术前左束支传导阻滞、膜间隔长度、植入深度、膜间隔长度与植入深度之差和植入深度>膜间隔长度可能是二叶式主动脉瓣患者经导管主动脉瓣置换术后新发传导异常的预测因素。受纳入研究数量与质量限制,上述结论尚需更多高质量研究予以验证。Objective To systematically review the predictive factors of new-onset conduction abnormalities(NOCAs)after transcatheter aortic valve replacement(TAVR)in bicuspid aortic valve(BAV)patients.Methods The CNKI,VIP,WanFang Data,PubMed,Cochrane Library and EMbase databases were electronically searched to collect the relevant studies on NOCAs after TAVR in patients with BAV from inception to December 5,2022.Two researchers independently screened the literature,extracted data,and assessed the risk of bias of the included studies.Meta-analysis was then performed by using RevMan 5.4 software.Results Six studies involving 758 patients with BAV were included.The results of the meta-analysis showed that age(MD=−1.48,95%CI−2.73 to−0.23,P=0.02),chronic kidney disease(OR=0.14,95%CI 0.06 to 0.34,P<0.01),preoperative left bundle branch block(LBBB)(OR=2.84,95%CI 1.11 to 7.23,P=0.03),membranous septum length(MSL)(MD=0.93,95%CI 0.05 to 1.80,P=0.04),implantation depth(ID)(MD=−2.06,95%CI−2.96 to−1.16,P<0.01),the difference between MSL and ID(MD=3.05,95%CI 1.92 to 4.18,P<0.01),and ID>MSL(OR=0.27,95%CI 0.15 to 0.49,P<0.01)could be used as predictors of NOCAs.Conclusion Current evidence shows that age,chronic kidney disease,LBBB,MS,ID,the difference between MSL and ID,and ID>MSL could be used as predictors of NOCAs.Due to the limited quantity and quality of included studies,more high-quality studies are required to verify the above conclusion.

关 键 词：二叶式主动脉瓣 经导管主动脉瓣置换术 新发传导异常 预测因素 META分析 

分 类 号：R654.2[医药卫生—外科学]