经导管主动脉瓣置换术后新发心房颤动的系统评价

发布时间：2018-04-26 19:09

本文选题：心脏瓣膜 + 人工　；参考：《中国循环杂志》2016年11期

【摘要】：目的:系统评价经导管主动脉瓣置换术后新发心房颤动(房颤)的发生率及预测因子。方法:全面检索Pub Med、Springer、Elsevier-SDOL、EMbase、SSCI、CNKI、VIP、中国生物医学文献数据库、万方数据资源系统在2009-01至2016-01期间发表的主动脉瓣置换术后新发房颤的研究文献。利用疾病患病率或发病率质量准则评价文献质量,运用Comprehensive Meta Analysis软件版本2.0进行Meta分析。结果:最终纳入14个研究,其中4个为多中心随机对照研究,共包含6 626例接受经导管主动脉瓣膜置换术的严重主动脉瓣狭窄患者。术后新发房颤的发生率为11.1%[95%可信区间(CI):10.3~11.9]。经导管主动脉瓣膜置换术后发生新发房颤的独立预测因子包括:经心尖途径[比值比(OR)=2.16,95%CI:1.58~2.94,P0.001]、手术相关心脏事件(OR=1.59,95%CI:1.08~2.36,P=0.01)、手术相关出血事件(OR=1.56,95%CI:1.00~2.45,P=0.04)、心房过大(每增加1mm/m~2,OR=1.21,95%CI:1.09~1.34,P0.001)。结论:经导管主动脉瓣置换术后新发房颤的发生率较高,且可能导致严重的临床不良事件。深入研究其预测因子有利于提高主动脉瓣置换术后的安全性。
[Abstract]:Objective: to evaluate the incidence and predictor of atrial fibrillation (AF) after transcatheter aortic valve replacement. Methods: Pub Meder Elsevier-SDOLE EMbase SSCIK VIPA, Chinese Biomedical Literature Database, Wanfang data Resource system published from 2009-01 to 2016-01 in the study of new atrial fibrillation after aortic valve replacement were searched. The quality criteria of disease prevalence or morbidity were used to evaluate the quality of literature, and the Meta analysis was carried out with Comprehensive Meta Analysis software version 2.0. Results: a total of 14 studies, 4 of which were multicenter randomized controlled, included 6,626 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. The incidence of postoperative new atrial fibrillation was 11.1% [95% CI: 10.3] 11.9]. Independent predictors of new atrial fibrillation after transcatheter aortic valve replacement include: transapical approach [ratio 2.1695CI1: 1.58 / 2.94 / P0.001], operation-related cardiac event OR1.599 / 95CIV1.082.36 P0.01, OR1.569 95 CI: 1.002.45 P0.04, atrial hypertrophy (1.21m95CI1.01.2m95CI1.01.295 / 1.34). Conclusion: the incidence of new atrial fibrillation after transcatheter aortic valve replacement is high and may lead to severe adverse clinical events. Further study of its predictors is helpful to improve the safety of aortic valve replacement.
【作者单位】：南京医科大学附属南京医院心血管内科;
【分类号】：R541.75;R654.2

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