Impact of Surgical and Transcatheter Aortic Valve Replacement in Low-Gradient Aortic Stenosis A Meta-Analysis

被引:27
作者
Ueyama, Hiroki [1 ,2 ]
Kuno, Toshiki [1 ]
Harrington, Matthew [1 ]
Takagi, Hisato [3 ]
Krishnamoorthy, Parasuram [2 ]
Sharma, Samin K. [2 ]
Kini, Annapoorna [2 ]
Lerakis, Stamatios [2 ]
机构
[1] Icahn Sch Med Mt Sinai, Mt Sinai Beth Israel, Dept Med, New York, NY 10029 USA
[2] Icahn Sch Med Mt Sinai, Mt Sinai Hosp, Div Cardiol, One Gustave L Levy Pl, New York, NY 10029 USA
[3] Shizuoka Med Ctr, Div Cardiovasc Surg, Shizuoka, Japan
关键词
aortic valve replacement; low-gradient aortic stenosis; transcatheter aortic valve replacement; VENTRICULAR EJECTION FRACTION; OPERATIVE RISK STRATIFICATION; LOW-FLOW; PROGNOSTIC-SIGNIFICANCE; SYMPTOMATIC PATIENTS; PREDICTORS; SURVIVAL; OUTCOMES; MULTICENTER; INTERVENTION;
D O I
10.1016/j.jcin.2021.04.038
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The aim of this study was to assess the impact of aortic valve replacement (AVR) on survival in patients with each subclass of low-gradient (LG) aortic stenosis (AS) and to compare outcomes following surgical AVR (SAVR) and transcatheter AVR (TAVR). BACKGROUND LG severe AS encompasses a wide variety of pathophysiology, including classical low-flow, LG (LF-LG), paradoxical LF-LG, and normal -flow, LG (NF-LG) AS, and uncertainty exists regarding the impact of AVR on each subclass of LG AS. METHODS PubMed and Embase were queried through October 2020 to identify studies comparing survival with different management strategies (SAVR, TAVR, and conservative) in patients with LG AS. Pairwise meta-analysis comparing AVR versus conservative management and network meta-analysis comparing SAVR versus TAVR versus conservative management were performed. RESULTS Thirty-two studies with a total of 6,515 patients and a median follow-up time of 24.2 months (interquartile range: 36.5 months) were included. AVR was associated with a significant decrease in all-cause mortality in classical LF-LG (hazard ratio [HR]: 0.42; 95% confidence interval [CI]: 0.36 to 0.48), paradoxical LF-LG (HR: 0.41; 95% CI: 0.29 to 0.57), and NF-LG (HR: 0.41; 95% CI: 0.27 to 0.62) AS compared with conservative management. SAVR and TAVR were each associated with a decrease in all-cause mortality in classical LF-LG (HR: 0.46 [95% CI: 0.38 to 0.55] and 0.49 [95% CI: 0.37 to 0.64], respectively), paradoxical LF-LG (HR: 0.42 [95% CI: 0.28 to 0.65] and 0.42 [95% CI: 0.25 to 0.72], respectively), and NF-LG (HR: 0.40 [95% CI: 0.21 to 0.77] and 0.46 [95% CI: 0.26 to 0.84], respectively) AS compared with conservative management. No significant difference was observed between SAVR and TAVR. CONCLUSIONS In all subclasses of LG AS, AVR was associated with a significant decrease in all-cause mortality regardless of surgical or transcatheter approach. (J Am Coll Cardiol Intv 2021;14:1481-92) (c) 2021 by the American College of Cardiology Foundation.
引用
收藏
页码:1481 / 1492
页数:12
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