Transcatheter Aortic Valve Replacement for the Treatment of Pure Native Aortic Valve Regurgitation: A Systematic Review

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• 作者：Anna Franzone ; MD^a ; Raffaele Piccolo ; MD^a ; George C.M. Siontis ; MD^a ; Jonas Lanz ; MD^a ; Stefan Stortecky ; MD^a ; Fabien Praz ; MD^a ; Eva Roost ; MD^b ; René ; Vollenbroich ; MD ; MPP^a ; Stephan Windecker ; MD^a ; Thomas Pilgrim ; MD^a ; ^{thomas.pilgrim@insel.ch" class="auth_mail" title="E-mail the corresponding author}
• 关键词：meta-analysis ; pure native aortic regurgitation ; systematic review ; transcatheter aortic valve replacement
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：28 November 2016
• 年：2016
• 卷：9
• 期：22
• 页码：2308-2317
• 全文大小：1661 K

文摘

This study sought to summarize available evidence on transcatheter aortic valve replacement (TAVR) for the treatment of native pure aortic regurgitation (AR).

d="absSec_2">Background

d="abspara0015">Surgical aortic valve replacement (SAVR) is the gold standard for the treatment of AR. However, case series of high-risk patients undergoing TAVR for native pure AR were reported.

d="absSec_3">Methods

d="abspara0020">We systematically searched Medline, Embase, and Scopus for reports of at least 5 patients with native pure AR undergoing TAVR. Patients’ and procedural characteristics were summarized. The primary outcome of interest was all-cause mortality. Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO (d="interref0015" class="interref" data-locatorType="url" data-locatorKey="http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016038422">CRD42016038422).

d="absSec_4">Results

d="abspara0025">Thirteen reports including 237 patients were included in the analysis. Self-expandable prostheses were used in 79% of patients, whereas 21% of the patients were treated with a balloon-expandable valve. Device success ranged between 74% and 100%. Seventeen patients (7%) required the implantation of a second valve. Conversion to SAVR was reported in 6 (2.5%) cases. The rate of all-cause mortality at 30 days amounted to 7% (95% confidence interval [CI]: 3% to 13%; I² = 37%). Cerebrovascular events were rare (0%, 95% CI: 0% to 1%; I² = 0); major bleeding and vascular complications occurred in 2% (95% CI: 0% to 7%; I² = 41%), and 3% (95% CI: 1% to 7%; I² = 0%), respectively. Permanent pacemaker implantation was required in 11% of patients (95% CI: 5% to 19%; I² = 50%). The rate of moderate or severe post-procedural AR amounted to 9% (95% CI: 0% to 28%; I² = 90%).

d="absSec_5">Conclusions

d="abspara0030">Among selected patients with native pure AR deemed at high risk for SAVR, TAVR is technically feasible and associated with an acceptable risk of early mortality.