Effects of Aortic Valve Replacement on Severe Aortic Stenosis and Preserved Systolic Function: Systematic Review and Network Meta-analysis.
Sci Rep
; 7(1): 5092, 2017 07 11.
Article
em En
| MEDLINE
| ID: mdl-28698585
ABSTRACT
The survival benefits of aortic valve replacement (AVR) in the different flow-gradient states of severe aortic stenosis (AS) is not known. A comprehensive search in PubMed/MEDLINE, Embase, Cochrane Library, CNKI and OpenGrey were conducted to identify studies that investigated the prognosis of severe AS (effective orifice area ≤1.0 cm2) and left ventricular ejection fraction ≥50%. Severe AS was stratified by mean pressure gradient [threshold of 40 mmHg; high-gradient (HG) and low-gradient (LG)] and stroke volume index [threshold of 35 ml/m2; normal-flow (NL) and low-flow (LF)]. Network meta-analysis was conducted to assess all-cause mortality among each AS sub-type with rate ratio (RR) reported. The effects of AVR on prognosis were examined using network meta-regression. In the pooled analysis (15 studies and 9,737 patients), LF states (both HG and LG) were associated with increased mortality rate (LFLG RR 1.88; 95% CI 1.43-2.46; LFHG RR 1.77; 95% CI 1.16-2.70) compared to moderate AS; and NF states in both HG and LG had similar prognosis as moderate AS (NFLG RR 1.11; 95% CI 0.81-1.53; NFHG RR 1.16; 95% CI 0.82-1.64). AVR conferred different survival benefits it was most effective in NFHG (RR with AVR /RR without AVR 0.43; 95% CI 0.22-0.82) and least in LFLG (RR with AVR /RR without AVR 1.19; 95% CI 0.74-1.94).
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Valva Aórtica
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Estenose da Valva Aórtica
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Sístole
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Substituição da Valva Aórtica Transcateter
Tipo de estudo:
Prognostic_studies
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Systematic_reviews
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Sci Rep
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Singapura