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Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta-analysis.

妊娠期经皮二尖瓣球囊扩张术: 系统回顾和荟萃分析。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14029
  • 作者列表:"Sreerama D","Surana M","Moolchandani K","Chaturvedula L","Keepanasseril A","Keepanasseril A","Pillai AA","Nair NS
  • 发表时间:2021-04-01
Abstract

INTRODUCTION:The objective of this study was to systematically review the maternal and fetal outcomes in pregnant women who underwent percutaneous balloon mitral valvuloplasty (PBMV) during pregnancy. MATERIAL AND METHODS:A search was conducted on MEDLINE and Embase databases to identify studies published between 2000 and 2018 that reported on maternal and fetal outcomes following PBMV performed in pregnancy. Randomized controlled trials, cohort studies, case-control studies, cross-sectional studies and case series with four or more pregnancies in which PBMV was performed during pregnancy were included. Reference lists from relevant articles were also hand-searched for relevant citations. A successful procedure was defined as one where there was a reported improvement in the valve area or reduction in the mitral valve gradient. A random effects model was used to derive pooled estimates of various outcomes and the final estimates were reported as percentages with a 95% confidence interval (95% CI). RESULTS:Twenty-one observational studies reporting 745 pregnancies were included in the review, all of them having reported outcomes without a comparison group. Most of the studies fell into the low-risk category as determined using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series. Most of the studies (86%) were reported from low- to middle-income countries and PBMV was mostly performed during the second trimester of pregnancy. Forty-three procedures (5.7%) were unsuccessful, nearly half (n = 19) of them reported among women with the severe subvalve disease (Wilkins subvalve score 3 or more). There were 11 maternal deaths among those with suboptimal valve anatomy (severe subvalve disease or Wilkin score >8). Mitral regurgitation was the most common cardiac complication (12.7%; 95% CI 7.3%-19.1%), followed by restenosis (2.4%; 95% CI 0.02%-7.2%). Pooled incidence of cesarean section was 12.1% (95% CI 3.6%-23.8%), preterm delivery 3.9% (95% CI 0.6%-9.0%), stillbirth 0.9% (95%CI 0.2%-2.2%) and low birthweight 5.4% (95% CI 0.2%-14.7%). CONCLUSIONS:PBMV may be an effective and safe procedure for optimizing outcomes in pregnant women with mitral stenosis in the absence of severe subvalve disease.

摘要

引言: 本研究的目的是系统评价妊娠期接受经皮球囊二尖瓣成形术 (PBMV) 的孕妇的母婴结局。 材料和方法: 在MEDLINE和Embase数据库中进行搜索,以确定2000年至2018年间发表的关于PBMV妊娠后母体和胎儿结局的研究。包括随机对照试验,队列研究,病例对照研究,横断面研究和在怀孕期间进行PBMV的四次或更多妊娠的病例系列。还手工搜索了相关文章的参考文献列表,以查找相关引文。成功的手术被定义为瓣膜面积有改善或二尖瓣梯度降低的手术。使用随机效应模型得出各种结局的汇总估计值,最终估计值以95% 置信区间 (95% CI) 的百分比形式报告。 结果: 21项观察性研究报告了745例妊娠被纳入审查,所有这些研究都报告了结局,没有对照组。使用Joanna Briggs研究所 (JBI) 病例系列关键评估清单确定,大多数研究属于低风险类别。大多数研究 (86%) 来自低收入至中等收入国家,PBMV主要在妊娠中期进行。43例手术 (5.7%) 不成功,其中近一半 (n = 19) 报告为患有严重瓣膜下疾病的女性 (Wilkins瓣膜下评分 ≥ 3分)。瓣膜解剖结构欠佳 (严重瓣下病变或Wilkin评分> 8分) 的产妇中有11例死亡。二尖瓣返流是最常见的心脏并发症 (12.7%; 95% CI 7.3%-19.1%),其次是再狭窄 (2.4%; 95% CI 0.02%-7.2%)。剖宫产率为12.1% (95% CI 3.6%-23.8%),早产发生率为3.9% (95% CI 0.6%-9.0%),死胎发生率为0.9% (95% CI 0.2%-2.2%),低出生体重发生率为5.4% (95% CI 0.2%-14.7%)。 结论: 对于无严重瓣下病变的二尖瓣狭窄孕妇,PBMV可能是一种有效且安全的优化结局方法。

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影响因子:2.68
发表时间:2021-02-01
DOI:10.1080/14656566.2020.1814255
作者列表:["Sawada H","Oeda T","Kohsaka M","Tomita S","Umemura A","Park K","Yamamoto K","Kiyohara K"]

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DOI:10.1007/s11033-021-06299-9
作者列表:["Louvrier A","Terranova L","Meyer C","Meyer F","Euvrard E","Kroemer M","Rolin G"]

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