经导管主动脉瓣置换术后新发心房颤动的系统评价

朱灏，任晓敏，蔡金赞，冒晨昱，潘道蓉，田乃亮，张瑶俊

临床研究

经导管主动脉瓣置换术后新发心房颤动的系统评价

朱灏，任晓敏*，蔡金赞，冒晨昱，潘道蓉，田乃亮，张瑶俊

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PubMed、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，P＜0.001]、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/m2，OR=1.21，95% CI：1.09～1.34，P＜0.001）。

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。

心脏瓣膜，人工；心房颤动；系统分析

Objective: To systematically review the occurrence rate and predictors of new-onset atrial fbrillation (NOAF) in patients after transcatheter aortic valve replacement (TAVR).

Methods: We completely searched PubMed, Springer, Elsevier-SDOL, EMbase, SSCI, CNKI, VIP, Chinese biomedical literature database, Wanfang data resource from 2009-01 to 2016-01 for literatures regarding NOAF after TAVR. The quality of literature was assessed by Loney criteria and Jadad scale; Meta analysis was conducted by Comprehensive Meta-analysis version 2.0 software.

Results: A total of 14 eligible studies including 4 multi center randomized clinical trial were fnally enrolled. There were 6626 patients with severe aortic valve stenosis received TAVR in our research. The post-procedural occurrence rate of NOAF was 11.1% (95% CI 10.3-11.9); the relevant predictors included trans-apical approach (OR=2.16, 95% CI 1.58-2.94, P＜0.001), operation related cardiac event (OR=1.59, 95% CI 1.08-2.36, P=0.01), operation related bleeding event (OR=1.56, 95% CI 1.004-2.45, P=0.04), larger atrial size, with each 1 mm/m² elevation (OR=1.21, 95% CI 1.09-1.34, P＜0.001).

Conclusion: The occurrence rate of NOAF was relatively high in patients with TAVR, which may incur severe clinical adverse event. Intensive study for its predictors could improve the safety of TAVR in relevant patients.

(Chinese Circulation Journal, 2016,31:1106.)

经导管主动脉瓣置换术（transcatheter aortic valve replacement，TAVR）是一种以介入方式完成主动脉瓣置换的新技术，由法国的Cribier等[1]于2002年首次报道，为失去外科手术机会的严重主动脉瓣狭窄（aortic stenosis，AS）患者的治疗带来了希望。PARTNER A研究表明TAVR治疗AS患者与传统的外科手术相比疗效相当，术后随访1年的死亡率没有明显差异[2]。同时PARTNER B研究表明TAVR治疗组患者1年的死亡率和复合终点事件发生率均显著低于药物保守治疗组[3]。……