Aortic valve replacement using stented or sutureless/rapid deployment prosthesis via either full-sternotomy or a minimally invasive approach: a network meta-analysis

Abstract

Background: New technologies such as sutureless or rapid deployment prosthetic valves and access via minimally invasive incisions offer alternatives to traditional full-sternotomy aortic valve replacement (SAVR). However, a comprehensive comparison of these surgical techniques along with alternative valve prosthesis has not been completed. Methods: Electronic databases were searched for studies comparing outcomes for SAVR, minimally invasive AVR (MiAVR), sutureless/rapid-deployment AVR (SuAVR) via full-sternotomy, or minimally invasive SuAVR (MiSuAVR) from their inception until September 2018. Early postoperative outcomes and follow-up data were included in a Bayesian network meta-analysis. Results: Twenty-three studies with 8,718 patients were identified. Compared with standard SAVR, SuAVR had significantly lower incidence of postoperative AF [odds ratio (OR) 0.33, 95% confidence interval (CI): 0.14-0.79, P=0.013] and MiSuAVR greater requirement for postoperative permanent pacemaker (OR 2.27, 95% CI: 1.25-4.14, P=0.008). All sutureless/rapid-deployment procedures had reduced cardiopulmonary bypass and cross-clamp times, by a mean of 25.9 and 25.0 min, respectively. Hospital length of stay (LOS), but not intensive care LOS, was reduced for all groups (MiAVR −1.53 days, MiSuAVR −2.79 days, and SuAVR 3.37 days). A signal towards reduced early mortality, wound infections, and acute kidney injury was noted in both sutureless/rapid-deployment and minimally invasive techniques but did not achieve significance. Sutureless/rapid-deployment procedures had favourable survival and freedom from valve related reoperation, however follow-up times were short and demonstrated significant heterogeneity between intervention groups. Conclusions: Minimally invasive and sutureless techniques demonstrate equivalent early postoperative outcomes to SAVR and may reduce ventilation time, hospital LOS and postoperative atrial fibrillation (POAF) burden.

The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

“…8 Minimally invasive SAVR, performed via upper hemisternotomy or right anterior thoracotomy, may reduce postoperative pain length of stay, and improve patient cosmesis compared to SAVR via median sternotomy, with similar rates of mortality and stroke. 57…”

“…8 Minimally invasive SAVR, performed via upper hemisternotomy or right anterior thoracotomy, may reduce postoperative pain length of stay, and improve patient cosmesis compared to SAVR via median sternotomy, with similar rates of mortality and stroke. 57 Therefore, the SAVR versus TAVR comparison, in the broad sense, comes from the clinical trials as summarized in this review. The SAVR versus TAVR team recommendation for the individual patient, and the subsequent patient choice, has multiple dimensions.…”

Right anterior mini thoracotomy approach for isolated aortic valve replacement: Early outcomes at a Canadian center

“…[15][16][17][18][19][20][21] Studies have also shown mis-AVR results in less blood transfusion, shorter assisted ventilatory time, lower stroke rates, and fewer patients with postoperative atrial fibrillation (AF). [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Sternum-sparing RAMT may be the optimal mis-AVR approach, with benefits of even less AF and shorter hospital stay when compared to upper hemisternotomy. 29 With demonstrated safety and favorable clinical outcomes, including patient satisfaction, the RAMT approach was incorporated into our minimally invasive valve surgery program in 2016.…”

“…There is increasing evidence that, when compared to sAVR, mis‐AVR is associated with better clinical outcomes, including reduced postoperative mortality and morbidity, shorter hospitalization, improved renal and pulmonary function, and reduced wound infection rates 15–21 . Studies have also shown mis‐AVR results in less blood transfusion, shorter assisted ventilatory time, lower stroke rates, and fewer patients with postoperative atrial fibrillation (AF) 19–33 …”

Sutureless and rapid deployment versus sutured aortic valve replacement: a propensity-matched comparison from the Sutureless and Rapid Deployment International Registry

“…to conventional sutured AVR in patients presenting with severe aortic valve disease 1 . Current SURD valve technologies were introduced about 15 years ago to reduce operative times and facilitate minimally invasive techniques 2,3 . Additionally, SURD-AVR demonstrated to improve valve hemodynamic and facilitate valve prosthesis implantation in challenging anatomical settings 4,5 .…”