Kevin Phan1, Yi-Chin Tsai1, Nithya Niranjan1, Denis Bouchard1, Thierry P Carrel1, Otto E Dapunt1, Harald C Eichstaedt1, Theodor Fischlein1, Borut Gersak1, Mattia Glauber1, Axel Haverich1, Martin Misfeld1, Peter J Oberwalder1, Giuseppe Santarpino1, Malakh Lal Shrestha1, Marco Solinas1, Marco Vola1, Tristan D Yan1, Marco Di Eusanio1. 1. 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
Abstract
BACKGROUND: Sutureless aortic valve replacement (SU-AVR) has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to reduce cross-clamp and cardiopulmonary bypass (CPB) duration and thereby improve surgical outcomes and facilitate a minimally invasive approach suitable for higher risk patients. The present systematic review and meta-analysis aims to assess the safety and efficacy of SU-AVR approach in the current literature. METHODS: Electronic searches were performed using six databases from their inception to January 2014. Relevant studies utilizing sutureless valves for aortic valve implantation were identified. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Twelve studies were identified for inclusion of qualitative and quantitative analyses, all of which were observational reports. The minimally invasive approach was used in 40.4% of included patients, while 22.8% underwent concomitant coronary bypass surgery. Pooled cross-clamp and CPB duration for isolated AVR was 56.7 and 46.5 minutes, respectively. Pooled 30-day and 1-year mortality rates were 2.1% and 4.9%, respectively, while the incidences of strokes (1.5%), valve degenerations (0.4%) and paravalvular leaks (PVL) (3.0%) were acceptable. CONCLUSIONS: The evaluation of current observational evidence suggests that sutureless aortic valve implantation is a safe procedure associated with shorter cross-clamp and CPB duration, and comparable complication rates to the conventional approach in the short-term.
BACKGROUND: Sutureless aortic valve replacement (SU-AVR) has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to reduce cross-clamp and cardiopulmonary bypass (CPB) duration and thereby improve surgical outcomes and facilitate a minimally invasive approach suitable for higher risk patients. The present systematic review and meta-analysis aims to assess the safety and efficacy of SU-AVR approach in the current literature. METHODS: Electronic searches were performed using six databases from their inception to January 2014. Relevant studies utilizing sutureless valves for aortic valve implantation were identified. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Twelve studies were identified for inclusion of qualitative and quantitative analyses, all of which were observational reports. The minimally invasive approach was used in 40.4% of included patients, while 22.8% underwent concomitant coronary bypass surgery. Pooled cross-clamp and CPB duration for isolated AVR was 56.7 and 46.5 minutes, respectively. Pooled 30-day and 1-year mortality rates were 2.1% and 4.9%, respectively, while the incidences of strokes (1.5%), valve degenerations (0.4%) and paravalvular leaks (PVL) (3.0%) were acceptable. CONCLUSIONS: The evaluation of current observational evidence suggests that sutureless aortic valve implantation is a safe procedure associated with shorter cross-clamp and CPB duration, and comparable complication rates to the conventional approach in the short-term.
Authors: Sven Martens; Andreas Zierer; Anja Ploss; Sami Sirat; Aleksandra Miskovic; Anton Moritz; Mirko Doss Journal: Innovations (Phila) Date: 2010-01
Authors: Ingo Breitenbach; Gerhard Wimmer-Greinecker; Leo A Bockeria; Jerzy Sadowski; Christoph Schmitz; Boguslaw Kapelak; Krzysztof Bartus; Ravil Muratov; Wolfgang Harringer Journal: J Thorac Cardiovasc Surg Date: 2010-08-02 Impact factor: 5.209
Authors: Alfred A Kocher; Günther Laufer; Axel Haverich; Malakh Shrestha; Thomas Walther; Martin Misfeld; Joerg Kempfert; Linda Gillam; Christoph Schmitz; Thorsten C Wahlers; Jens Wippermann; Friedrich W Mohr; Matthias Roth; Adalbert Skwara; Parwis Rahmanian; Dominik Wiedemann; Michael A Borger Journal: J Thorac Cardiovasc Surg Date: 2012-10-08 Impact factor: 5.209
Authors: Willem Flameng; Marie-Christine Herregods; Hadewich Hermans; Gerry Van der Mieren; Monique Vercalsteren; Gert Poortmans; Jan Van Hemelrijck; Bart Meuris Journal: J Thorac Cardiovasc Surg Date: 2011-04-07 Impact factor: 5.209
Authors: James M Brown; Sean M O'Brien; Changfu Wu; Jo Ann H Sikora; Bartley P Griffith; James S Gammie Journal: J Thorac Cardiovasc Surg Date: 2009-01 Impact factor: 5.209
Authors: Christopher Cao; Su C Ang; Praveen Indraratna; Con Manganas; Paul Bannon; Deborah Black; David Tian; Tristan D Yan Journal: Ann Cardiothorac Surg Date: 2013-01
Authors: Marco Di Eusanio; Francesco Saia; Giovanni Pellicciari; Kevin Phan; Marinella Ferlito; Gianni Dall'Ara; Roberto Di Bartolomeo; Antonio Marzocchi Journal: Ann Cardiothorac Surg Date: 2015-03
Authors: Marco Di Eusanio; Kevin Phan; Denis Bouchard; Thierry P Carrel; Otto E Dapunt; Roberto Di Bartolomeo; Harald C Eichstaedt; Theodor Fischlein; Thierry Folliguet; Borut Gersak; Mattia Glauber; Axel Haverich; Martin Misfeld; Peter J Oberwalder; Giuseppe Santarpino; Malakh Lal Shrestha; Marco Solinas; Marco Vola; Francesco Alamanni; Alberto Albertini; Gopal Bhatnagar; Michel Carrier; Stephen Clark; Federic Collart; Utz Kappert; Alfred Kocher; Bart Meuris; Carmelo Mignosa; Ahmed Ouda; Marc Pelletier; Parwis Baradaran Rahmanian; David Reineke; Kevin Teoh; Giovanni Troise; Emmanuel Villa; Thorsten Wahlers; Tristan D Yan Journal: Ann Cardiothorac Surg Date: 2015-03