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.
PMID : 29548584
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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
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