医学
心脏病学
内科学
钙化
危险系数
心室流出道
心肌梗塞
心室
优势比
置信区间
心脏骨骼
冲程(发动机)
主动脉瓣
主动脉
主动脉根
工程类
机械工程
作者
Michel Pompeu Sá,Jef Van den Eynde,John H. Malin,Gianluca Torregrossa,Serge Sicouri,Basel Ramlawi
摘要
To assess the impact of left ventricle outflow tract calcification (LVOT) on the outcomes of transcatheter aortic valve implantation (TAVI).Meta-analysis including studies published by October 2021. Primary endpoints were operative and 1-year mortality. The secondary endpoints were stroke, myocardial infarction, paravalvular leakage (PVL), new permanent pacemaker implantation (PPI), aortic annulus/root rupture.Nine studies met our eligibility criteria, including a total of 4459 patients (1330 patients with significant LVOT calcification and 3129 patients without significant LVOT calcification). Pooled risk of operative death was higher in the group with significant LVOT calcification (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.33-3.91; p < .001). Worse 1-year survival was observed in the group with LVOT calcification (hazard ratio 1.53, 95% CI: 1.26-1.87, p < .001). Patients with significant LVOT calcification had higher risk of stroke (OR: 1.83; 95% CI: 1.08-3.09; p = .032), myocardial infarction (OR: 1.74; 95% CI: 1.08-2.80; p = .034), PVL (OR: 1.88; 95% CI: 1.09-3.22; p = .028) and aortic annulus/root rupture (OR: 7.48; 95% CI: 3.58-15.65; p = .002). We did not observe a statistically significant difference in the pooled results for new PPI between the groups (OR: 1.19; 95% CI: 0.79-1.80; p = .337).The presence of significant LVOT calcification increases the risk of periprocedural and 1-year mortality, stroke, myocardial infarction, PVL and aortic annulus/root rupture after TAVI. Self-expandable valves may be a preferrable option in this scenario. Structural heart surgeons and interventional cardiologists should consider this factor when referring patients for TAVI and technical aspects (such as the type of transcatheter heart valve to be deployed or the use of pre-/post-dilatation) should be factored in.
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