论文部分内容阅读
目的:应用Meta分析的方法来评价经导管主动脉瓣膜植入术(TAVI)治疗二叶式主动脉瓣(BAV)重度狭窄的有效性及安全性.方法:通过计算机检索建库至2016年8月PubMed、The Cochrance Library、Embase、中国知网和万方数据库中发表的有关TAVI治疗BAV重度狭窄的疗效与安全性的前瞻性队列研究.同时,手工检索纳入文献的参考文献,查找相关研究.筛选文献、提取资料和评估纳入研究的质量后,采用STATA12软件进行荟萃分析.结果:纳入5项前瞻性队列研究,共2244例患者.NOS评分最高为8分,最低为7分,说明纳入文献质量较好.荟萃分析显示:所绘制的漏斗图显示散点均匀分布于中线两侧,Begg及Egger检验显示P值均＞0.05,提示各项研究无明显发表偏倚.与非BVA狭窄组相比较,BAV狭窄组瓣膜置入成功率(RR1.019,95％CI 0.982～1.057,P=0.327)、平均跨瓣压差(SMD 0.004,95％CI0.194～0.186,P=0.969)、30 d死亡率(RR 1.211,95％CI 0.525～2.794,P=0.653)、30 d复合终点事件发生率(RR 1.096,95％CI 0.684～1.757,P=0.703)、瓣周漏(≥2级)发生率(RR 1.365,95％CI 0.959～1.943,P=0.084)、起搏器植入率(RR 0.836,95％CI 0.517～1.352,P=0.465)、严重血管并发症发生率(RR 1.085,95％CI 0.401～2.936,P=0.872)及致命性出血发生率(RR 0.632,95％CI 0.296～1.348,P=0.235)差异均无统计学意义.结论:对于不适合进行外科手术的BAV重度狭窄患者,TAVI是可行、安全和有效的.“,”Objective:To assess the efficacy and safety of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) patients through a meta-analysis.Method:A systematic literature review was performed by searching eligible articles in PubMed,The Cochrance Library,EMBASE,Wangfang Date and CNKI.Publications were selected according to inclusion and exclusion standard.Meta-analyses was performed with the software of STATA 12.0.Relative risks (RRs),standardized mean difference (SMD) and the corresponding 95％ confidence intervals (CIs) were used to compare clinical outcomes of BAV patients and non-BAV patients.Result:A total of 5 articles,including 123 BAV and 2121 non-BAV patients undergoing TAVI,were analyzed.The NOS score of eligible studies was from 7 to 8,suggesting that all included cohort studies were of relatively high quality.Publication bias was assessed with Egger\'s score (P＞0.05) that was not significant,and Begg\'s score (P＞0.05) that was also non-significant.These results suggested that significant publication bias was unlikely in included cohort studies.Between the BAV and no-BAV cohorts,there was no difference in device success rate(RR 1.019,95％CI 0.982～1.057,P=0.327),post-TAVI mean peak gradients (SMD 0.004,95％CI 0.194～0.186,P=0.969),30 day mortality (RR 1.211,95％CI 0.525～2.794,P=0.653),30-day composite endpoint evenrs(RR 1.096,95 ％ CI 0.684 ～ 1.757,P =0.703),moderate or severe paravalvular leak (RR 1.365,95 ％ CI 0.959 ～ 1.943,P=0.084),pacemaker implantations (RR 0.836,95％CI 0.517～ 1.352,P=0.465),vascular complications (RR 1.085,95％CI 0.401～～2.936,P=0.872) and life threatening bleeding (RR 0.632,95％CI 0.296～1.348,P =0.235).Conclusion:The present studies suggested that TAVI may be a feasible and safe treatment modality for BAV patients.While future randomised trials are not likely,larger adequately-powered multiinstitutional studies are warranted to assess the long-term durability and complications associated with TAVI in older BAV patients with severe aortic stenosis.