Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies

Takagi, Hisato; Umemoto, Takuya

doi:10.1016/j.jjcc.2015.09.009

Cited by 24 publications

(21 citation statements)

References 27 publications

(56 reference statements)

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“…However, when a comparison with conventional AVR was made, outcomes were burdened by similar mortality but a reduced rate of permanent pacemaker implantation 51 . These results confirm the findings of a previous meta-analysis including 5,000 high-risk patients in which sutureless valve–AVR produced a reduction in early mortality and postoperative paravalvular leak 52 and echo the data from Biancari et al . in intermediate-risk patients 53 .…”

Section: Transcatheter Aortic Valve Replacements: Results and Comparisupporting

confidence: 91%

Recent advances in aortic valve replacement

Spadaccio

Alkhamees²,

Al‐Attar

2019

F1000Res

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Aortic valve replacement has stood the test of time but is no longer an operation that is exclusively approached through a median sternotomy using only sutured prostheses. Currently, surgical aortic valve replacement can be performed through a number of minimally invasive approaches employing conventional mechanical or bioprostheses as well as sutureless valves. In either case, the direct surgical access allows inspection of the valve, complete excision of the diseased leaflets, and debridement of the annulus in a controlled and thorough manner under visual control. It can be employed to treat aortic valve pathologies of all natures and aetiologies. When compared with transcatheter valves in patients with a high or intermediate preoperative predictive risk, conventional surgery has not been shown to be inferior to transcatheter valve implants. As our understanding of sutureless valves and their applicability to minimally invasive surgery advances, the invasiveness and trauma of surgery can be reduced and outcomes can improve. This warrants further comparative trials comparing sutureless and transcatheter valves.

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Section: Transcatheter Aortic Valve Replacements: Results and Comparisupporting

confidence: 91%

Recent advances in aortic valve replacement

Spadaccio

Alkhamees²,

Al‐Attar

2019

F1000Res

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“…Other groups have used sutureless aortic valves in high-risk patients suffering from multiple-valve disease, with excellent results [ 22 ]. Takagi et al [ 23 ], in a recent meta-analysis of comparative studies between sutureless valves and TAVI, demonstrated a statistically significant reduction in early mortality in favor of sutureless valves over TAVI (2.5% vs. 7.3%; OR, 0.33 95% CI, 0.16–0.69; p=0.003) and a significant reduction of paravalvular leakage (3.5% vs. 33.2%; OR, 0.09; 95% CI, 0.05–0.16; p<0.00001), which has a significant influence on late mortality, as previously described. Furthermore, the economic impact of TAVI on society should not be underestimated, which clearly favor sutureless aortic valves [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Valve-in-Valve Replacement Using a Sutureless Aortic Valve

et al. 2016

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Patient: Female, 61Final Diagnosis: Tissue degenerationSymptoms: DyspneaMedication: —Clinical Procedure: Redo valve replacementSpecialty: SurgeryObjective:Rare diseaseBackground:We present a unique case of a 61-year-old female patient with homograft deterioration after redo surgery for prosthetic valve endocarditis with root abscess.Case Report:The first operation was performed for type A dissection with root, arch, and elephant trunk replacement of the thoracic aorta. The present re-redo surgery was performed as valve-in-valve with a sutureless aortic biopros-thesis. The postoperative course was uneventful and the patient was discharged on day 6.Conclusions:The current case report demonstrates that sutureless bioprostheses are an attractive option for surgical valve-in-valve procedures, which can reduce morbidity and mortality.

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“…Moreover, these valve types facilitate minimally invasive AVR, which was limited in the past due to extended procedural times. Consecutively, several reports and meta-analyses compared AVR using sutureless and rapid-deployment aortic valves to TAVI [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. The results led to the common conclusion supporting the use of SURD-AVR as an alternative to TAVI in high- or intermediate-risk patients requiring aortic valve replacement.…”

Section: Introductionmentioning

confidence: 99%

Are Sutureless and Rapid-Deployment Aortic Valves a Serious Alternative to TA-TAVI? A Matched-Pairs Analysis

Al-Maisary

Farag

Gussinklo

et al. 2021

JCM

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Background: Transcatheter aortic valve implantation is a feasible alternative to conventional aortic valve replacement with expanding indication extending to low-risk patients. Sutureless and rapid-deployment aortic valves were developed to decrease procedural risks in conventional treatment. This paired-match analysis aims to compare patients undergoing surgical transcatheter aortic valve implantation to sutureless and rapid-deployment aortic valve implantation. Methods: Retrospective database analysis between 2010 and 2016 revealed 214 patients undergoing transcatheter aortic valve implantation procedures through surgical access (predominantly transapical) and 62 sutureless and rapid-deployment aortic valve procedures including 26 patients in need of concomitant coronary artery bypass surgery. After matching, 52 pairs of patients were included and analyzed. Results: In-hospital death (5.8% vs. 3.8%; p = 0.308) was comparable between transcatheter aortic valve implantation (mean age 77 ± 4.3 years) and sutureless and rapid-deployment aortic valve implantation groups (mean age 75 ± 4.0 years), including 32 females in each group. The logistic EuroSCORE was similar (19 ± 12 vs. 17 ± 10; p = 0.257). Postoperative renal failure (p = 0.087) and cerebrovascular accidents (p = 0.315) were without significant difference. The incidence of complete heart block requiring permanent pacemaker treatment was relatively low for both groups (1.9% vs. 7.7%; p = 0.169) for TAVI and sutureless and rapid-deployment valves respectively. Intraoperative use of blood transfusion was higher in the sutureless and rapid-deployment aortic valve implantation group (0.72 U vs. 1.46 U, p = 0.014). Estimated survival calculated no significant difference between both groups after 6 months (transcatheter aortic valve implantation: 74 ± 8% vs. sutureless and rapid-deployment aortic valve implantation: 92 ± 5%; log rank p = 0.097). Conclusion: Since sutureless and rapid-deployment aortic valve implantation is as safe and effective as transapical transcatheter aortic valve implantation, combining the advantage of standard diseased-valve removal with shorter procedural times, sutureless and rapid-deployment aortic valve replacement may be considered as an alternative for patients with elevated operative risk considered to be in the “gray zone” between transcatheter aortic valve implantation and conventional surgery, especially if concomitant myocardial revascularization is required.

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Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies

Abstract: Compared with TAVI, sutureless AVR may be associated with a reduction in early mortality and postoperative paravalvular AR.

Cited by 24 publications

References 27 publications

Recent advances in aortic valve replacement

Recent advances in aortic valve replacement

Valve-in-Valve Replacement Using a Sutureless Aortic Valve

Are Sutureless and Rapid-Deployment Aortic Valves a Serious Alternative to TA-TAVI? A Matched-Pairs Analysis

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