Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation

被引:62
作者
Takagi, Hisato [1 ]
Umemoto, Takuya [1 ]
机构
[1] Shizuoka Med Ctr, Dept Cardiovasc Surg, 762-1 Nagasawa,Shimizu Cho, Shizuoka 4118611, Japan
关键词
LONG-TERM SURVIVAL; HEMODYNAMIC PERFORMANCE; CLINICAL IMPACT; REPLACEMENT; STENOSIS; BIOPROSTHESES; METAANALYSIS; OUTCOMES; PREDICTORS; MORTALITY;
D O I
10.1016/j.athoracsur.2015.11.048
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. We reviewed currently available studies that investigated prosthesis-patient mismatch (PPM) in transcatheter aortic valve implantation (TAVI) with a systematic literature search and meta-analytic estimates. Methods. To identify all studies that investigated PPM in TAVI, MEDLINE and EMBASE were searched through August 2015. Studies considered for inclusion met the following criteria: the study population included patients undergoing TAVI and outcomes included at least post-procedural PPM prevalence. We performed three quantitative meta-analyses about (1) PPM prevalence after TAVI, (2) PPM prevalence after TAVI versus surgical aortic valve replacement (SAVR), and (3) late all-cause mortality after TAVI in patients with PPM versus patients without PPM. Results. We identified 21 eligible studies that included data on a total of 4,000 patients undergoing TAVI. The first meta-analyses found moderate PPM prevalence of 26.7%, severe PPM prevalence of 8.0%, and overall PPM prevalence of 35.1%. The second meta-analyses of six studies, including 745 patients, found statistically significant reductions in moderate (p = 0.03), severe (p = 0.0003), and overall (p = 0.02) PPM prevalence after TAVI relative to SAVR. The third meta-analyses of five studies, including 2,654 patients, found no statistically significant differences in late mortality between patients with severe PPM and patients without PPM (p = 0.44) and between patients with overall PPM and patients without PPM (p = 0.97). Conclusions. Overall, moderate, and severe PPM prevalence after TAVI was 35%, 27%, and 8%, respectively, which may be less than that after SAVR. In contrast to PPM after SAVR, PPM after TAVI may not impair late survival. (C) 2016 by The Society of Thoracic Surgeons
引用
收藏
页码:872 / 880
页数:9
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