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
in 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).
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Aortic Valve
/
Aortic Valve Stenosis
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Systole
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Transcatheter Aortic Valve Replacement
Type of study:
Prognostic_studies
/
Systematic_reviews
Limits:
Aged
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Aged80
/
Female
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Humans
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Male
/
Middle aged
Language:
En
Journal:
Sci Rep
Year:
2017
Document type:
Article
Affiliation country:
Singapore
Publication country:
ENGLAND
/
ESCOCIA
/
GB
/
GREAT BRITAIN
/
INGLATERRA
/
REINO UNIDO
/
SCOTLAND
/
UK
/
UNITED KINGDOM