Direct comparison of rapid deployment versus sutureless aortic valve replacement: a meta-analysis

Abstract

Background: This meta-analysis was conducted to compare the procedural and early outcomes of aortic valve replacement (AVR) using rapid deployment valve (RD group) versus sutureless valve (SU group). Methods: A literature search of 5 online databases was conducted. The primary outcomes were mean transvalvular pressure gradient (MPG) after AVR, the incidence of paravalvular leak (PVL) and the need for a permanent pacemaker implantation (PPI). The secondary outcomes included aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times, early mortality and other postoperative complications, such as atrial fibrillation, bleeding reoperation and stroke.Results: Eight articles were included, and all outcomes except MPG after AVR in matched valve sizes were extracted from 7 studies (RD group =842 patients and SU group =1,386 patients). The pooled analysis demonstrated a lower MPG in the RD group than in the SU group, with mean difference (MD) of 2.64 mmHg. The pooled risk ratios of any PVL and grade ≥2 (or moderate) PVL were not significantly different between the groups; however, the incidence of PPI was significantly lower in the RD group than in the SU group, with a risk ratio of 0.69. The pooled analyses showed that the ACC and CPB times were significantly longer in the RD group than in the SU group, with weighted MDs of 8.74 (P<0.001) and 9.94 (P<0.001) minutes, respectively. The risks of early mortality and other postoperative complications were not significantly different between the groups.Conclusions: AVR using RD valve was associated with better valve hemodynamics in terms of the MPG than AVR using SU valve, and better outcomes were observed in the RD group regarding PPI. Procedural times were longer in AVR using RD valve than SU valve. Early clinical outcomes showed no difference between RD and SU valve.

Sutureless vs. rapid-deployment valve: a systemic review and meta-analysis for a direct comparison of intraoperative performance and clinical outcomes

“…Theoretically, in terms of valve structure, as the Intuity valve has the valve annulus stent covered by a polyester sealing cloth ( 8 , 30 ), the Perceval valve could offer a larger effective outflow orifice area, leading to its better hemodynamic performance. Nevertheless, this hypothesis is in stark contrast to our meta-analysis observation, which should be highlighted purposely.…”

“…Therefore, the Perceval valve is the only one that precisely matches the definition of “sutureless” during operation. Because of these structural and procedural differences with the Perceval valve, some opponents have argued that the Intuity valve cannot strictly be labeled as a “rapid-deployment” valve ( 30 ). However, it was noted that the magnitude assessment showed high heterogeneity, with subgroup analysis and leave-one-out sensitivity analysis being inefficient for elimination.…”

“…Two meta-analyses ( 30 , 34 ) anchored on the comparison of the sutureless and rapid-deployment aortic valves in SURD-AVR had been published before our study was done. Nevertheless, two aspects (paravalvular leak and pacemaker implantation) of our analysis presented negative results, showing slight differences with the conclusions of the two previous studies.…”

The Aortic Annulus Stabilization Technique Prevents Paravalvular Leaks after Rapid Deployment Aortic Valve Implantation

“…In fact, the rapid deployment Intuity valve features a sub-annular balloon-expanding stent that is dilated after the placement of the valve into the annulus. The effectiveness of this anchoring system depends on the intraoperative valve sizing as well as on the characteristics of the aortic annulus when the radial forces of the stent apply against it [7,[11][12][13]. In order to reduce the risk of PVL and to anchor the valve, the balloon-expanding stent is intraoperatively ballooned with 4.5 or 5.0 atmospheres, depending on the valve size.…”

“…Moreover, despite the enlargement of the sub-valvular stent, there is still a risk of postoperative PVL, which can lead to an increased mortality rate when moderate or severe, or can cause haemolysis when it is generated by small defects with high-velocity jets [14]. In the TRITON study as well as in other published retrospective studies, the average rate of mild-to-severe postoperative paravalvular leak after Intuity valve implantation still ranges between 1.4% and 13%, and some patients required surgical reoperations in order to address this issue [1][2][3][5][6][7][9][10][11][12][13].…”