Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: A meta-analysis.

Sohn, Suk Ho; Jang, Myoung-Jin; Hwang, Ho Young; Kim, Kyung Hwan
The Journal of thoracic and cardiovascular surgery
2018Jun ; 155 ( 6 ) :2402-2412.e5.
저자 상세정보
Sohn, Suk Ho - Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Jang, Myoung-Jin - Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Hwang, Ho Young - Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. Electronic address scalpel@hanmail.net.
Kim, Kyung Hwan - Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
ABSTRACT
OBJECTIVES: This meta-analysis was conducted to compare the early and follow-up outcomes of aortic valve replacement using rapid deployment or sutureless (RD) valves (RDAVR group) with aortic valve replacement using conventional bioprostheses (CAVR group).

METHODS: A literature search of 5 online databases was conducted. The primary outcomes were postoperative complications and the secondary outcomes included the aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times and early mortality and all-cause mortality during follow-up.

RESULTS: Twenty-one articles (RDAVR group?=?1297 patients; CAVR group?=?1488 patients) were selected. The pooled analyses showed that the ACC and CPB times were significantly shorter in the RDAVR group than in the CAVR group (mean difference, -26.34; 95% confidence interval [CI], -31.86 to -20.82 and mean difference, -25.33; 95% CI, -30.79 to -19.87, respectively). The pooled risk ratios (RRs) of any paravalvular leak and permanent pacemaker (PPM) insertion were significantly higher in the RDAVR group than in the CAVR group (RR, 2.32; 95% CI, 1.53-3.51 and RR, 2.08; 95% CI, 1.49-2.90, respectively). The pooled analysis showed that the risk of a paravalvular leak grade ?? in the RDAVR group did not significantly differ between the RDAVR and CAVR groups (RR, 2.05; 95% CI, 0.71-5.93). The risk of PPM insertion remained significant when only studies reporting adjusted outcomes were pooled. The risks of other postoperative complications, early mortality, and all-cause mortality during follow-up were not significantly different between the RDAVR and CAVR groups.

CONCLUSIONS: RDAVR is associated with significantly shorter ACC and CPB times than CAVR, although this difference did not translate into improved postoperative outcomes, early mortality, and all-cause mortality during follow-up. Care might be needed when implanting RD valves because they are associated with a higher incidence of PPM insertion, regardless of the RD valve type. CI - Copyright ??2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
keyword
aortic valve replacement; meta-analysis; rapid deployment; sutureless
링크

주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
ACC and CPB times were significantly shorter in the RDAVR group than in the CAVR group (mean difference, -26.34; 95% confidence interval [CI], -31.86 to -20.82 and mean difference, -25.33; 95% CI, -30.79 to -19.87, respectively). The pooled risk ratios (RRs) of any paravalvular leak and permanent pacemaker (PPM) insertion were significantly higher in the RDAVR group than in the CAVR group (RR, 2.32; 95% CI, 1.53-3.51 and RR, 2.08; 95% CI, 1.49-2.90, respectively).
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
DOI
10.1016/j.jtcvs.2018.01.084.
KCD코드
ICD 03
건강보험코드