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

Sohn, Suk Ho; Jang, Mijung; Hwang, Ho Young; Kim, Kyung Hwan

doi:10.1016/j.jtcvs.2018.01.084

Cited by 45 publications

(39 citation statements)

References 44 publications

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“…Ghoneim and colleagues studied the outcomes of various biological valve options, including stentless valves, stented valves and SU-AVR, and reported similar postoperative transvalvular gradient in the SU-AVR group compared with the stented group 34. The similarity in postoperative transvalvular gradient between SU-AVR and conventional biological valves was also reported in a meta-analysis by Sohn and colleagues 21. More data from randomised trials will be required in order to determine if SU-AVR prostheses truly have superior haemodynamics when compared with conventional valves.…”

Section: Specific Indications For Sutureless Valvesmentioning

confidence: 70%

“…In a recent meta-analysis by Sohn and colleagues which compared SU-AVR with conventional bioprosthetic valves, there was a significant reduction in CCT and CPB times in SU-AVR patients21 (table 1). However, the investigators concluded that these reductions did not translate into improvements in perioperative outcomes, in particular early mortality.…”

Section: Sutureless Valves Versus Conventional Avrmentioning

confidence: 98%

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Sutureless aortic valve prostheses

Bilkhu

Borger

Briffa

et al. 2019

Heart

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Conventional surgical aortic valve replacement (AVR) is the ‘gold standard’ for treatment of severe or symptomatic aortic valve stenosis. The increasing age of patients and increasing comorbidities has led to the development of procedures to minimise operative time and reduce risks of surgery. One method of reducing operative times is the use of sutureless aortic valves (SU-AVR). We examine the current literature surrounding the use of SU-AVR. Alternatives to AVR are SU-AVR, sometimes referred to as rapid deployment valves, or transcatheter aortic valve implantation (TAVI). TAVI has been demonstrated to be superior over medical therapy in patients deemed inoperable and non-inferior in high and intermediate-risk patients compared with surgical AVR. However, the lack of excision of the calcified aortic valve and annulus raises concerns regarding long-term durability and possibly thromboembolic complications. TAVI patients have increased rates of paravalvular leaks, major vascular complications and pacemaker implantation when compared with conventional AVR. SU-AVR minimises the need for suturing, leading to reduced operative times, while enabling complete removal of the calcified valve. The increase in use of SU-AVR has been mostly driven by minimally invasive surgery. Other indications include patients with a small and/or calcified aortic root, as well as patients requiring AVR and concomitant surgery. SU-AVR is associated with decreased operative times and possibly improved haemodynamics when compared with conventional AVR. However, this has to be weighed against the increased risk of paravalvular leak and pacemaker implantation when deciding which prosthesis to use for AVR.

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Section: Specific Indications For Sutureless Valvesmentioning

confidence: 70%

Section: Sutureless Valves Versus Conventional Avrmentioning

confidence: 98%

Sutureless aortic valve prostheses

Bilkhu

Borger

Briffa

et al. 2019

Heart

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“…Due to the design of sutureless valves, their implantation in AVR is positioned below the aortic annulus, which increases the risk of atrioventricular block . On the other hand, PVL is suspected to be an adverse outcome as a result of inadequate positioning and sizing of sutureless valves or incomplete annulus decalcification . In recent years, two case reports from the literature have reported valve perforation following the use of Cor‐Knot device, leading to valvular regurgitation .…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, the use of Cor‐Knot in heart valve surgery is not associated with postoperative complications including the risk of PPI and PVL . In contrast, recent meta‐analyses have reported that sutureless technology is associated with increased risk of PPI and PVL . Sutureless valve is an alternative surgical adjunct that replaces the conventional prosthetic valve and boasts its reduced need for sutures, thereby minimizing CPB and AXT .…”

Section: Discussionmentioning

confidence: 99%

What is the safety and efficacy of the use of automated fastener in heart valve surgery?

et al. 2019

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Introduction: Cor-Knot automated fastener has been used as an adjunct in heart valve surgery to eliminate the need for manual tying during valve implantation. Although reduced operative time and facilitation for minimally invasive surgery are clear benefits, whether their use translates to improved patient outcome remains debatable. This study aims to review the safety and efficacy of automated fasteners in heart valve surgeries. Method: Specific searches were conducted via online medical databases (Pubmed, Embase, Ovid) between 1950 and June 2019. Longitudinal studies were included that provided operative parameters. Results: The initial literature search identified 3773 articles, but only eight met the inclusion criteria and were used for analysis: four studies related to aortic valve replacement (AVR), four related to mitral valve (MV) intervention (total n = 810). The meta-analysis revealed the significantly shorter aortic cross-clamp time in the Cor-knot group compared to manual tying, both in AVR and MV surgeries (P < .05). Cardiopulmonary bypass time was significantly shorter in the Cor-knot group when analyzing studies in MV surgery (weighted mean difference [WMD]: 110.0; 95% confidence interval: 12.3-207.7; P = .027) The use of Cor-Knot did not increase the risk of permanent pacemaker implantation, paravalvular leak, and 30-day mortality. The majority of studies reported no change in the length of intensive unit care and total hospital stay. Conclusion:We confirmed that the majority of existing literatures indicated the safety and intraoperative efficacy with automated fastener application. Nevertheless, there is currently no evidence to support automated fastened sutures can translate its intraoperative advantages to improved patient outcome. K E Y W O R D S aortic, automated fastener, clinical review, cor-knot, heart valves, mitral 1 | BACKGROUND Surgery for valvular heart disease is well-established and remains a superior treatment option for many valvular pathologies in many patient groups. Both replacement (with prosthetic valves) and repair Abbreviations: AS, aortic stenosis; AVR, aortic valve replacement; AXT, aortic cross-clamp time; CPB, cardiopulmonary bypass time; ICU, intensive care unit; LV, left ventricular; Mini-AVR, minimally invasive aortic valve replacement; Mini-MV repair, minimally invasive mitral valve repair; MR, mitral regurgitation; MV, mitral valve; PPI, permanent pacemaker implantation; PVL, paravalvular leak; TAVR, transcatheter aortic valve replacement. Lueh Chien and M. Yousuf Salmasi are Joint first authors.

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“…Rapid deployment valves have reduced cross‐clamp and bypass times with excellent 1‐year performance 9 . While the use of rapid deployment valves for aortic valve replacement has not been shown to be superior to conventional bioprosthetic valves, 10 there are scenarios where it is favorable, such as a calcified aortic root 11 …”

Section: Commentsmentioning

confidence: 99%

Placement of a rapid deployment aortic valve in a patient with severely calcified aortic root homograft

et al. 2020

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Significant aortic calcification is a known sequelae of homograft aortic root replacement and creates a treatment challenge if these patients require cardiac reintervention. The standard surgical option for patients requiring an aortic valve replacement in the setting of a calcified aortic homograft has been a Bentall procedure, which is high‐risk with extended cross‐clamp, cardiopulmonary bypass and operative times. We present a patient with a severely calcified aortic homograft who underwent successful valve replacement using a rapid deployment aortic valve leaving the aortic root and arch intact and avoiding the more extensive redo aortic root replacement. Similar cases in the literature are rare.

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

Cited by 45 publications

References 44 publications

Sutureless aortic valve prostheses

Sutureless aortic valve prostheses

What is the safety and efficacy of the use of automated fastener in heart valve surgery?

Placement of a rapid deployment aortic valve in a patient with severely calcified aortic root homograft

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