Shinn, Sung Ho; Altarabsheh, Salah E; Deo, Salil V; Sabik, Joseph H; Markowitz, Alan H; Park, Soon J
The Annals of thoracic surgery
2018Apr ; 15 ( 6 ) :.
PMID : 29709503
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Shinn, Sung Ho - Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Jeju, Repulic of Korea. Electronic address shinnsungho@gmail.com.
Altarabsheh, Salah E - Department of Cardiovascular Surgery, Queen Alia Heart Institute, Jordan, Amman.
Deo, Salil V - Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio.
Sabik, Joseph H - Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio.
Markowitz, Alan H - Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio.
Park, Soon J - Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio.
ABSTRACT
BACKGROUND: Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) are increasingly adopted methods to treat high-risk patients with severe aortic valve stenosis. We conducted a systematic review and meta-analysis to compare the clinical outcomes between these two recent methods to treat aortic valve disease.
METHODS: We systematically searched multiple databases (January 2000 to October 2016) to identify original studies comparing clinical outcome between SU-AVR and TAVI. End points studied were early mortality, development of paravalvular leak, early stroke, bleeding events, and the need for pacemaker insertion. A random-effect inverse-variance weighted analysis was performed. Event rates were compared as odds ratio (OR) and 95% confidence interval (CI).
RESULTS: The meta-analysis included seven observational studies comprising 617 SU-AVR and 621 TAVI patients. Early mortality was 2.5% and 5% in the SU-AVR and TAVI cohorts, respectively (OR, 0.52; 95% CI, 0.30 to 0.90; p?= 0.02; I(2)?= 2%). Postprocedural significant paravalvular leak was much lower after SU-AVR (OR, 0.18l; 95% CI, 0.11 to 0.30; p < 0.0001). Postprocedural stroke (OR, 0.71; 95% CI, 0.24 to 2.08; p?=?0.53) and the need for pacemaker insertion (OR, 0.884; 95% CI, 0.364 to 2.18; p?= 0.7) were comparable between the two cohorts.
CONCLUSIONS: Our meta-analysis of observational studies demonstrates that early mortality is lower after SU-AVR than after TAVI in selected patients. The rates of stroke and pacemaker implant are comparable between procedures; however, the incidence of paravalvular leak is higher after TAVI. CI - Copyright ??2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
keyword
Aortic stenosis; Suture-less aortic valve replacement; trans-catheter aortic valve implantation
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