期刊
INTERNATIONAL JOURNAL OF CARDIOLOGY
卷 370, 期 -, 页码 112-121出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2022.11.012
关键词
Heart valve prosthesis implantation; Transcatheter aortic valve replacement; Heart valve diseases; Cardiac surgical procedures; Cardiovascular surgical procedures; Meta -analysis
The study found that ViV-TAVI is associated with a decreased risk of all-cause mortality in the short term after the procedure compared to redo SAVR. However, over time, redo SAVR seems to be protective against all-cause mortality. These results should be interpreted with caution as they are based on pooled data from observational studies, and further clinical trials are needed.
Aims: To evaluate all-cause mortality in ViV-TAVI versus redo SAVR in patients with failed bioprostheses.Methods: Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of nonrandomized studies published by September 30, 2021.Results: Ten studies met our eligibility criteria and included a total of 3345 patients (1676 patients underwent ViV-TAVI and 1669 patients underwent redo SAVR). Pooling all the studies, ViV-TAVI showed a lower risk of allcause mortality in the first 44 days [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.49-0.93, P = 0.017], with an HR reversal after 197 days favoring redo SAVR (HR 1.53; 95% CI 1.22-1.93; P < 0.001). Pooling only the matched populations (1143 pairs), ViV-TAVI showed a lower risk of all-cause mortality in the first 55 days [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.45-0.89, P < 0.001], with a reversal HR after 212 days favoring redo SAVR (HR 1.57; 95% CI 1.22-2.03; P < 0.001). The Cox regression model showed a statistically significant association of prosthesis-patient mismatch (PPM) with all-cause mortality during follow-up for ViVTAVI (HR 1.03 per percentage increase in the study- and treatment arm-level proportion of PPM, 95% 1.02-1.05, P < 0.001).Conclusion: ViV-TAVI is associated with a strong protective effect immediately after the procedure in comparison with redo SAVR, however, this initial advantage reverses over time and redo SAVR seems to be a protective factor for all-cause mortality after 6 months. Considering that these results are the fruit of pooling data from observational studies, they should be interpreted with caution and trials are warranted.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据