健康发展与政策研究2025，Vol.28Issue(2)：179-185,7.DOI:10.12458/HDPR.202407128
经导管与外科主动脉瓣置换术的中长期安全性与有效性
Mid-and long-term safety and efficacy of transcatheter and surgical sortic valve replacement
贾慧茹 1申东东 1张新颖 1向晨 1张治国 2肖月 3沈丽宁4
作者信息
- 1. 华中科技大学同济医学院医药卫生管理学院,湖北 武汉 430030
- 2. 华中科技大学同济医学院医药卫生管理学院,湖北 武汉 430030||湖北省卫生技术评估研究中心,湖北 武汉 430030
- 3. 国家心理健康和精神卫生防治中心,北京 100029
- 4. 华中科技大学同济医学院医药卫生管理学院,湖北 武汉 430030||湖北省卫生技术评估研究中心,湖北 武汉 430030||华中科技大学同济医学院健康医疗大数据科学研究中心,湖北 武汉 430030
- 折叠
摘要
Abstract
Objective To systematically evaluate the mid-and long-term safety and efficacy of TAVR versus SAVR for severe aortic stenosis(AS)treatment.Methods Randomized controlled trials(RCTs)comparing TAVR with SAVR in patients with severe AS were retrieved from CNKI,Wanfang,VIP,PubMed,EMBASE,Web of Science,and CENTRAL up to March 25,2024,followed by a meta-analysis.The GRADE approach was used to evaluate the evidence quality of the outcome measures.Results Seven studies involving 7 758 patients were included.The all-cause mortality(33.1%vs 30.4%)and cardiovascular mortality(23.6%vs 21.6%)were higher in the TAVR group than those in the SAVR group.The differences were all statistically significant(all P＜0.05).The re-intervention rate(1.3%vs 2.3%),new permanent pacemaker implantation rate(10.7%vs 21.6%),and major vascular complication rate(3.0%vs 9.2%)after SAVR were all lower than those in the TAVR group(all P＜0.01).The incidences of new-onset atrial fibrillation(16.4%vs 33.9%)and major bleeding(20.7%vs 26.7%)in the TAVR group were lower than those in the SAVR group,and all differences have the statistical significance(all P＜0.01).No significant differences were observed between the two groups in stroke,endocarditis,myocardial infarction,or rehospitalization rates(all P＞0.05).According to the GRADE assessment,one outcome was rated as high-quality,eight as moderate,and one each as low-and very-low-quality.Conclusions TAVR is associated with higher mid-to-long-term mortality in patients with severe AS.The risks of complications such as reintervention and new permanent pacemaker implantation should be taken into consideration in treatment choices.Larger scale in long-term follow-up studies are needed to provide stronger evidence for the clinical application and promotion of TAVR.关键词
主动脉瓣狭窄/经导管主动脉瓣置换术/外科主动脉瓣置换术/Meta分析Key words
aortic stenosis/transcatheter aortic valve replacement/surgical aortic valve replacement/meta-analysis分类
医药卫生引用本文复制引用
贾慧茹,申东东,张新颖,向晨,张治国,肖月,沈丽宁..经导管与外科主动脉瓣置换术的中长期安全性与有效性[J].健康发展与政策研究,2025,28(2):179-185,7.
