Direct and adjusted indirect comparisons of perioperative mortality after sutureless or rapid-deployment aortic valve replacement versus transcatheter aortic valve implantation

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• 作者：Hisato Takagi^a ; ¹ ; ^{kfgth973@ybb.ne.jp} ; Tomo Ando^b ; ¹ ; Takuya Umemoto^a ; for the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
• 关键词：ACC ; aortic cross-clamp ; AS ; aortic stenosis ; AVR ; aortic valve replacement ; C-AVR ; conventional AVR ; CI ; confidence interval ; CPB ; cardiopulmonary bypass ; DC ; direct comparison ; DC-MA ; DC meta-analysis ; E/e&prime ; early mitral velocity/annulus velocity ; EF ; ejection fraction ; EuroSCORE ; European System for Cardiac Operative Risk Evaluation ; HR ; hazard ratio ; IDC ; adjusted indirect comparison ; IDC-MA ; IDC meta-analysis ; OR ; odds ratio ; PAR ; paravalvular aortic regurgitation ; PARTNER ; Placement
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：327-334
• 全文大小：935 K
• 卷排序：228

文摘

To determine which procedure, aortic valve replacement (AVR) with a sutureless or rapid-deployment prosthesis (SL-AVR) or transcatheter aortic valve implantation (TAVI), achieves better perioperative survival for severe aortic stenosis (AS), we conducted direct-comparison meta-analyses (DC-MAs) and an adjusted indirect-comparison meta-analysis (IDC-MA).MethodsWe searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through April 2016. Eligible studies were randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. We performed a DC-MA-[A] of SL-AVR versus TAVI, a DC-MA-[B] of SL-AVR versus conventional AVR (C-AVR), and a DC-MA-[C] TAVI versus C-AVR. Then, we computed a IDC-MA-[A′] of TAVI versus SL-AVR from the results of the DC-MA-[B] and the DC-MA-[C].ResultsWe identified 6 RCTs and 30 PSM studies enrolling a total of 15,887 patients. The 3 DC-MAs demonstrated significantly lower perioperative (30-day or in-hospital) all-cause mortality after SL-AVR than after TAVI (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.28 to 0.80; p = 0.005) and no significant differences between SL-AVR and C-AVR (OR, 1.07; 95% CI, 0.60 to 1.94; p = 0.81) and between TAVI and C-AVR (1.07; 95% CI, 0.90 to 1.27; p = 0.45). The computed IDC-MA-[A′] indicated no significant difference in mortality between SL-AVR and TAVI (1.01; 95% CI, 0.54 to 1.86). Combining the results of the DC-MA-[A] and IDC-MA [A′] showed significantly lower mortality after SL-AVR than after TAVI (OR, 0.65; 95% CI, 0.44 to 0.97; p = 0.03).ConclusionsFor patients with severe AS, SL-AVR may achieve better perioperative survival than TAVI.