经导管二尖瓣置换术与二次手术二尖瓣置换术疗效对比的荟萃分析  

Transcatheter mitral valve replacement versus redo surgical mitral valve replacement:a systematic review and meta-analysis

作　　者：刘洪序 刘光祖 陈阳[1] 卫治理 黎旭华 陈浩[1] 宋兵[1] Liu Hongxu;Liu Guangzu;Chen Yang;Wei Zhili;Li Xuhua;Chen Hao;Song Bing(Department of Cardiovascular Surgery,The First Hospital of Lanzhou University,The First School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院兰州大学第一医院心血管外科,730000

出　　处：《中国心血管杂志》2024年第1期65-72,共8页Chinese Journal of Cardiovascular Medicine

基　　金：甘肃省自然科学基金(22JR11RA037)。

摘　　要：目的比较经导管二尖瓣置换术(TMVR)与二次手术二尖瓣置换术(redo SMVR)对二尖瓣生物瓣衰败或成形环失效患者的疗效。方法计算机检索PubMed、The Cochrane Library、Web of Science、Embase、中国知网(CNKI)、维普(VIP)、万方和中国生物医学文献数据库(CBM),检索时限为建库至2023年8月,检索有关TMVR对比redo SMVR对二尖瓣生物瓣衰败或成形环失效患者临床疗效的随机对照试验和队列研究。按照纳入与排除标准筛选文献、提取资料和评价纳入研究质量,采用RevMan 5.3和Stata 14.0软件进行荟萃分析。结果最终纳入13项队列研究,共计14226例患者,其中TMVR患者3379例,redo SMVR患者10847例。荟萃分析结果显示,TMVR患者的术后院内死亡率(OR=0.76,95%CI:0.63~0.90,P=0.002)、院内脑血管事件(OR=0.48,95%CI:0.36~0.63,P<0.001)、院内出血事件(OR=0.24,95%CI:0.18~0.32,P<0.001)、院内急性肾损伤(OR=0.52,95%CI:0.45~0.60,P<0.001)、永久起搏器植入(OR=0.25,95%CI:0.18~0.35,P<0.001)、院内心原性休克(OR=0.49,95%CI:0.34~0.72,P<0.001)、主动脉内球囊反搏(OR=0.41,95%CI:0.19~0.91,P=0.030)、新发心房颤动(OR=0.22,95%CI:0.07~0.74,P=0.010)、手术时间(WMD=-225.88,95%CI:-283.56~-168.19,P<0.001)、重症监护室时间(WMD=-2.02,95%CI:-2.32~-1.72,P<0.001)、住院时间(WMD=-5.97,95%CI:-7.87~-4.06,P<0.001)均小于redo SMVR患者,而TMVR患者的1年二尖瓣平均跨瓣压(WMD=1.30,95%CI:0.76~1.84,P<0.001)高于redo SMVR患者,且TMVR和redo SMVR患者术后1年死亡率(OR=1.06,95%CI:0.70~1.61,P=0.770)、2年死亡率(OR=1.90,95%CI:0.98~3.66,P=0.060)比较,差异均无统计学意义。结论TMVR与redo SMVR相比,短期安全性更高,早期并发症较少,术后恢复更快,但术后1、2年死亡率无明显差异。Objective To compare the effectiveness and safety for transcatheter mitral valve replacement(TMVR)versus redo surgical mitral valve replacement(redo SMVR)in patients with failed mitral bioprostheses or failed annuloplasty rings.Methods PubMed,The Cochrane Library,Web of Science,Embase,China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP),Wanfang Data and China Biology Medicine(CBM)were searched from inception until August 2023.Two reviewers independently screened the literatures,extracted the data and evaluated the quality of the included studies by the criteria of inclusion and exclusion.Then,RevMan 5.3 and Stata 16.0 software was used for meta-analysis.Results A total of thirteen cohort studies were included with 14226 patients,including 3379 patients of TMVR and 10847 patients of redo SMVR.Meta-analysis results showed,compared with the redo SMVR patients,the TMVR patients had lower in-hospital mortality(OR=0.76,95%CI:0.63 to 0.90,P=0.002),lower incidence of in-hospital stroke(OR=0.48,95%CI:0.36 to 0.63,P<0.001),lower incidence of bleeding events(OR=0.24,95%CI:0.18 to 0.32,P<0.001),lower incidence of acute kidney injury(OR=0.52,95%CI:0.45 to 0.60,P<0.001),lower incidence of permanent pacemaker implantation(OR=0.25,95%CI:0.18 to 0.35,P<0.001),lower incidence of in-hospital cardiogenic shock(OR=0.49,95%CI:0.34 to 0.72,P<0.001),lower intra-aortic balloon pump(OR=0.41,95%CI:0.19 to 0.91,P=0.030),lower incidence of new-onset atrial fibrillation(OR=0.22,95%CI:0.07 to 0.74,P=0.010),less operation time(WMD=-225.88,95%CI:-283.56 to-168.19,P<0.001),shorter length of stay in the ICU(WMD=-2.02,95%CI:-2.32 to-1.72,P<0.001)and shorter length of stay in the hospital(WMD=-5.97,95%CI:-7.87 to-4.06,P<0.001).But the mitral valve mean gradient(WMD=1.30,95%CI:0.76 to 1.84,P<0.001)at 1 year postoperative of patients undergone TMVR was higher than redo SMVR group.There was no difference in 1-year mortality(OR=1.06,95%CI:0.70 to 1.61,P=0.770)and 2-years mortality(OR=1.90,95%CI:0.98 to 3.66,P=

关 键 词：经导管二尖瓣置换术 瓣中瓣 环中瓣 二次手术 生物瓣衰败 成形环失效 META分析 

分 类 号：R654.2[医药卫生—外科学]