Rapid deployment technology versus conventional sutured bioprostheses in aortic valve replacement.
J Card Surg
; 37(3): 640-655, 2022 Mar.
Article
em En
| MEDLINE
| ID: mdl-35028981
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Estenose da Valva Aórtica
/
Bioprótese
/
Próteses Valvulares Cardíacas
/
Implante de Prótese de Valva Cardíaca
Tipo de estudo:
Clinical_trials
/
Observational_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
J Card Surg
Assunto da revista:
CARDIOLOGIA
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Reino Unido