Rapid deployment technology versus conventional sutured bioprostheses in aortic valve replacement

Abstract

Objectives: Despite the benefits of rapid deployment aortic valve prostheses (RDAVR), conventional sutured valves (cAVR) are more commonly used in the treatment for aortic stenosis. Given the paucity of randomized studies, this study aimed to synthesize available data to compare both treatment options. Methods: A systematic search of Pubmed, OVID, and MEDLINE was conducted to retrieve comparative studies for RDAVR versus cAVR in the treatment of aortic stenosis. Out of 1773 returned titles, 35 papers were used in the final analysis, including 1 randomized study, 1 registry study, 6 propensity-matched studies, and 28 observational studies, incorporating a total of 10,381 participants (RDAVR n = 3686; cAVR n = 6310). Results: Random-effects meta-analysis found no difference between the two treatment groups in terms of operative mortality, stroke, or bleeding (p > .05). The RDAVR group had reduced cardiopulmonary bypass (standardized mean difference [SMD]: −1.28, 95% confidence interval [CI]: [−1.35, −1.20], p < .001) and cross-clamp times (SMD: −1.05, 95% CI: [−1.12, −0.98], p < .001). Length of stay in the intensive care unit was also shorter in the RDAVR group (SMD: −0.385, 95% CI: [−0.679, −0.092], p = .010). The risk of pacemaker insertion was higher for RDAVR (odds ratio [OR]: 2.41, 95% CI: [1.92, 3.01], p < .001) as was the risk of paravalvular leak (PVL) at midterm follow-up (OR: 2.52, 95% CI: [1.32, 4.79], p = .005). Effective orifice area and transvalvular gradient were more favorable in RDAVR patients (p > .05).Conclusions: Despite the benefits of RDAVR in terms of reduced operative time and enhanced recovery, the risk of pacemaker insertion and midterm PVL remains a significant cause for concern.

The Novel Use of a Rapid Deployment Valve in Type A Aortic Dissection

“…Thus, a decision was made to replace the aortic valve. The native aortic valve was excised, and the annulus was debrided Innovations 19 (2) from calcium and measured to fit a 19 mm bioprosthetic valve. The dissection flap in the noncoronary sinus was repaired with injecting BioGlue into the false lumen.…”

Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations

“… 49 Another meta-analysis demonstrated that PVL is significantly more prevalent in SRDV than SAVR using a stented bioprosthesis, and a sub-analysis by prosthetic valve type also corroborated this finding. 8 Even mild PVL can have a significant impact on survival in both conventional SAVR and TAVR, 51 , 52 highlighting the importance of careful attention to PVL in SRDV. If left untreated, PVL can lead to increased diastolic left ventricular pressure and volume overload.…”

“… 6 However, high rates of permanent pacemaker implantation (PPI) and paravalvular leakage (PVL) are two potential drawbacks of SRDV compared to SAVR using a stented bioprosthesis. 7 , 8 Despite recent cumulative experiences with SRDV have been reported recently, there is no specific recommendation for SRDV in the current guidelines, 9 , 10 and the appropriate indication for SRDV is still to be defined. This review discusses the technique of SAVR using SRDV, and specific considerations including appropriate patient selection.…”

The role of sutureless or rapid‐deployment aortic valve prosthesis in bicuspid aortic valve: Standard AVR, TAVR, or somewhere in between?

“…In addition, SU-AVR is known to be associated with a higher risk of rhythm disturbance or postoperative pacemaker implantation compared to the standard AVR. 1,[3][4][5]8,9 Finally, SU-AVR may pose an unknown risk of reoperation on a rapid deployment or sutureless bioprosthesis or the proximal aorta down the road. Although SU-AVR may facilitate minimally invasive approach such as right thoracotomy or upper hemisternotomy, 2,10 all factors mentioned above may eliminate the benefits expected in standard AVR using a stented bioprosthesis in the low-risk, young population given a longer life expectancy and the component of aortopathy in BAV patients which may develop with time.…”

“…These patients' background is different from the tricuspid AS population who are usually older and may have concomitant coronary artery and/or mitral valve diseases. In addition, SU‐AVR is known to be associated with a higher risk of rhythm disturbance or postoperative pacemaker implantation compared to the standard AVR 1,3–5,8,9 . Finally, SU‐AVR may pose an unknown risk of reoperation on a rapid deployment or sutureless bioprosthesis or the proximal aorta down the road.…”