摘要
目的:评价左心室辅助装置(left ventricular assist device, LVAD)植入同期行二尖瓣手术(mitral valve surgery, MVS)干预术前严重二尖瓣反流(mitral regurgitation, MR)对临床预后的影响。方法:检索PubMed、Embase、Cochrane Library、Web of Science数据库中建库起至2022年10月10日关于比较LVAD植入是否同期行MVS干预术前MR的文献。主要研究终点为全因死亡率,次要终点为术后MR复发、再入院等并发症。采用STATA 15.1软件进行统计学分析。结果:最终纳入7项回顾性队列研究,共5 504例患者,仅517例(9.4%)同期行MVS。荟萃分析显示,同期行MVS没有增加术后近、中期死亡率,MVS组、No-MVS组术后30 d全因死亡率分别为4.3%、4.9%;MVS组术后1年(RR=0.83,95%CI:0.65~1.08,P=0.384)、2年(RR=0.83,95%CI:0.66~1.03,P=0.446)和3年(RR=0.78,95%CI:0.62~0.97,P=0.162)全因死亡风险有下降趋势,但差异无统计学意义。同期行MVS没有增加术后中远期再入院的风险,MVS组术后1年(RR=0.33,95%CI:0.17~0.62,P=0.209)、2年(RR=0.34,95%CI:0.21~0.57,P=0.315)因心力衰竭再入院的风险明显下降,但差异无统计学意义。结论:LVAD植入同期行MVS干预术前严重的MR是安全可行的,没有增加术后近中期全因死亡率和再入院率,似乎可以降低术后中远期全因死亡和再入院的风险。
Objective To evaluate the impact of left ventricular assist device(LVAD)implantation concomitant with mitral valve surgery(MVS)to intervene in preoperative significant mitral regurgitation(MR)on clinical prognosis.Methods The PubMed,Embase,Cochrane Library,and Web of Science databases were searched for literature on comparing LVAD implantation with or without concomitant MVS intervention for preoperative MR from inception to 10 October 2022.The primary study endpoint was all-cause mortality,and secondary endpoints were complications such as postoperative MR recurrence and readmission.Statistical analysis was performed using STATA 15.1 software.Results A total of 7 retrospective cohort studies with 5500 patients were included,and only 517(9.4%)patients received concomitant MVS.Meta-analysis showed that concomitant MVS did not increase postoperative early and mid-term mortality,with all-cause mortality rates of 4.3%and 4.9%at 30 days postoperatively in the MVS and No-MVS groups,respectively.There was a trend towards a decreased risk of all-cause mortality in the MVS group at 1 year(RR=0.83,95%CI:0.65-1.08,P=0.384),2 years(RR=0.83,95%CI:0.66-1.03,P=0.446),and 3 years(RR=0.78,95%CI:0.62-0.97,P=0.162)after surgery,but the differences were not statistically significant.Concomitant MVS did not increase the risk of mid-to long-term postoperative readmission,and the risk of readmission for heart failure was lower in the MVS group at 1 year(RR=0.33,95%CI:0.17-0.62,P=0.209)and 2 years(RR=0.34,95%CI:0.21-0.57,P=0.315)after surgery,but the differences were not statistically significant.Conclusion Concomitant MVS with LVAD implantation to intervene preoperative severe MR is safe and feasible,which does not increase the rate of early and mid-term postoperative all-cause mortality and readmission,and seems to reduce the risk of mid to long-term all-cause mortality and readmission.
作者
王志华
胡俊龙
赵泽原
李建朝
陈志高
李昭
程兆云
WANG Zhihua;HU Junlong;ZHAO Zeyuan;LI Jianchao;CHEN Zhigao;LI Zhao;CHENG Zhaoyun(Department of Cardiac Surgery,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou,451464,China;Department of Extracorporeal Circulation,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou,451464,China)
出处
《临床心血管病杂志》
CAS
2024年第1期69-75,共7页
Journal of Clinical Cardiology
基金
河南省重点研发专项(No:221111310300)
河南省医学科技攻关计划项目(No:LHGJ20220111)
河南省医学科技攻关计划项目(No:SBGJ202101005)。
关键词
心力衰竭
二尖瓣反流
左心室辅助装置
二尖瓣手术
荟萃分析
heart failure
mitral regurgitation
left ventricular assist device
mitral valve surgery
meta-analysis
