| OBJECTIVE: To summarize the preliminary clinical experience by studying the clinical data and prognosis of 12 patients with aortic stenosis treated with transcatheter aortic valve replacement(TAVR).The efficacy of TAVR compared with SAVR in the database was also analyzed to assess the efficacy of TAVR.METHODS: The clinical data of patients with severe aortic stenosis who underwent transcatheter aortic valve implantation in our hospital from December2017 to February 2020 were collected,and the general clinical data,intraoperative and postoperative conditions were retrospectively analyzed.At the same time,systematic literature search was done from the The Chinese and English databases of Pub Med、EMbase、The Cochrane Library、CNKI、CBM、Wanfang、VIP.Randomized controlled trials on transcatheter aortic valve replacement compared with surgical aortic valve replacement were included.Endpoints included allcause mortality,stroke,new or worsening atrial fibrillation,serious fatal bleeding,major vascular complications,permanent pacemaker implantation,and moderate to severe paravalvular leakage.Effect sizes were described by relative risks(RR)with 95% confidence intervals(95% CI).Results: A total of 12 patients with aortic stenosis underwent TAVR in our hospital,with mean age of(68.5 ± 5.3)years,STS score of(3.66 ± 1.65)points and Euroscore II score of(1.94 ± 1.14)points.All patients completed the operation,without intraoperative death.The success rate of operation was 100%.Postoperative death occurred in 1 case,stroke in 1 case,moderate perivalvular leakage in 1 case,and pulmonary infection in 4 cases.The follow-up results at 3months after operation showed that the symptoms were significantly improved.Compare to pre-op,the left ventricular ejection fractions was improved(63.10 ±10.62:55.50 ± 16.43,P < 0.05),and the transaortic pressure gradient before operation was significantly decreased(29.00 ± 15.88:99.60 ± 25.16,P < 0.05).In addition,a total of 7 randomized controlled studies comparing the efficacy of TAVR and SAVR were included.The results showed that compared with SAVR,there was no significant difference in all-cause mortality at 30 days,1 year and 5years after TAVR(RR = 0.79,95% CI: 0.60-1.04,P = 0.09;RR = 0.92,95% CI:0.81-1.04,P = 0.18;RR = 1,95% CI: 0.91-1.11,P = 0.94,respectively),and there was no statistical significance in the incidence of stroke events at 30 days and 1year after TAVR(RR = 0.82,95% CI: 0.66-1.02,P = 0.07;RR = 0.87,95% CI:0.73-1.03,P = 0.11,respectively).Among the common complications,TAVR was associated with significantly fewer new and worsening atrial fibrillation and fatal bleeding events than SAVR,and higher rates of major vascular complications,permanent pacemaker implantation,and moderate to severe paravalvular leakage.Conclusion: Transcatheter aortic valve replacement can significantly reduce the transaortic pressure gradient,improve systolic function and improve the clinical symptoms of patients with aortic stenosis.TAVR can be an effective and reasonable new option for the treatment of aortic stenosis. |
