Michael L Williams1,2,3,4, Campbell D Flynn2,5, Andrew A Mamo6, David H Tian2,7, Utz Kappert8, Manuel Wilbring8, Thierry Folliguet9, Antonio Fiore9, Antonio Miceli10, Augusto D'Onofrio11, Giorgia Cibin11, Gino Gerosa11, Mattia Glauber12, Theodor Fischlein13, Francesco Pollari13. 1. Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia. 2. The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia. 3. The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia. 4. The University of Sydney, Sydney, Australia. 5. Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Melbourne, Australia. 6. Department of Cardiology, Prince of Wales Hospital, Sydney, Australia. 7. Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia. 8. Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany. 9. Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France. 10. Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy. 11. Division of Cardiac Surgery, University of Padova, Padova, Italy. 12. Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio - Gruppo San Donato, Milano, Italy. 13. Cardiac Surgery, Paracelsus Medical University - Klinikum Nürnberg, Nuremberg, Germany.
Abstract
BACKGROUND: Sutureless and rapid-deployment aortic valve replacement (SURD-AVR) has become a prominent area of research as the medical community evaluate its place amongst other aortic valve interventions. The main advantages of SURD-AVR established to date are the reduced cross-clamp and cardiopulmonary bypass (CPB) times, as well as facilitating minimally invasive surgery in high-risk surgical patients. This current systematic review and meta-analysis, to our knowledge, is the first focusing on long-term outcomes regarding safety, efficacy and durability of SURD-AVR from available current literature. METHODS: A literature search via six electronic databases was performed from their inception to November 2019. Inclusion criteria for this systematic review included survival and postoperative echocardiographic outcomes greater than five years in patients who underwent SURD-AVR with either Perceval or Intuity valves. Studies were identified and data extracted by two independent reviewers. Long-term survival outcomes were aggregated using digitized Kaplan-Meier curves where available. RESULTS: After applying predefined inclusion and exclusion criteria, four studies were identified for review. All four studies were observational and in total reported data for 1,998 patients. Almost half (42.4%) of patients underwent SURD-AVR via full sternotomy, with almost one third (30.1%) also undergoing concomitant cardiac procedures. Aggregate overall survival rates at 1-, 2-, 3-, and 5-year follow-up were 94.9%, 91.2%, 89.0%, and 84.2%, respectively. Incidence of strokes (4.8%), severe paravalvular leaks (PVLs) (1.5%) and permanent pacemaker (PPM) insertion (8.2%) at up to 5-year follow-up were acceptable. At 5-year follow-up hemodynamic outcomes were also acceptable for mean pressure gradient (MPG) (range, 8.8-13.6 mmHg), peak pressure gradient (PPG) (range, 18.9-21.1 mmHg) and effective orifice area (EOA) (range, 1.5-1.8 cm2). CONCLUSIONS: Evaluation of the evidence reporting long-term outcomes of SURD-AVR suggests that it is a safe procedure for AVR with low rates of complications. Long-term outcomes presented in this review show that not only does SURD-AVR have acceptable survival rates, but also good hemodynamic performance at 5-year follow-up. 2020 Annals of Cardiothoracic Surgery. All rights reserved.
BACKGROUND: Sutureless and rapid-deployment aortic valve replacement (SURD-AVR) has become a prominent area of research as the medical community evaluate its place amongst other aortic valve interventions. The main advantages of SURD-AVR established to date are the reduced cross-clamp and cardiopulmonary bypass (CPB) times, as well as facilitating minimally invasive surgery in high-risk surgical patients. This current systematic review and meta-analysis, to our knowledge, is the first focusing on long-term outcomes regarding safety, efficacy and durability of SURD-AVR from available current literature. METHODS: A literature search via six electronic databases was performed from their inception to November 2019. Inclusion criteria for this systematic review included survival and postoperative echocardiographic outcomes greater than five years in patients who underwent SURD-AVR with either Perceval or Intuity valves. Studies were identified and data extracted by two independent reviewers. Long-term survival outcomes were aggregated using digitized Kaplan-Meier curves where available. RESULTS: After applying predefined inclusion and exclusion criteria, four studies were identified for review. All four studies were observational and in total reported data for 1,998 patients. Almost half (42.4%) of patients underwent SURD-AVR via full sternotomy, with almost one third (30.1%) also undergoing concomitant cardiac procedures. Aggregate overall survival rates at 1-, 2-, 3-, and 5-year follow-up were 94.9%, 91.2%, 89.0%, and 84.2%, respectively. Incidence of strokes (4.8%), severe paravalvular leaks (PVLs) (1.5%) and permanent pacemaker (PPM) insertion (8.2%) at up to 5-year follow-up were acceptable. At 5-year follow-up hemodynamic outcomes were also acceptable for mean pressure gradient (MPG) (range, 8.8-13.6 mmHg), peak pressure gradient (PPG) (range, 18.9-21.1 mmHg) and effective orifice area (EOA) (range, 1.5-1.8 cm2). CONCLUSIONS: Evaluation of the evidence reporting long-term outcomes of SURD-AVR suggests that it is a safe procedure for AVR with low rates of complications. Long-term outcomes presented in this review show that not only does SURD-AVR have acceptable survival rates, but also good hemodynamic performance at 5-year follow-up. 2020 Annals of Cardiothoracic Surgery. All rights reserved.
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