Kei Woldendorp1,2,3, Mathew P Doyle2,3, Paul G Bannon1,2,3,4, Martin Misfeld3,4,5, Tristan D Yan2,3,6, Giuseppe Santarpino7,8,9, Paolo Berretta10, Marco Di Eusanio10, Bart Meuris11, Alfredo Giuseppe Cerillo12, Pierluigi Stefàno12,13, Niccolò Marchionni13,14, Jacqueline K Olive15, Tom C Nguyen16,17, Marco Solinas18, Giacomo Bianchi18. 1. Sydney Medical School, The University of Sydney, Sydney, Australia. 2. The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia. 3. Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. 4. Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia. 5. University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany. 6. Sydney Adventist Hospital, Sydney, Australia. 7. Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy. 8. Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany. 9. Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy. 10. Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy. 11. Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium. 12. Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy. 13. University of Florence School of Medicine, Florence, Italy. 14. Unit of Cardiology, Careggi University Hospital, Florence, Italy. 15. Baylor College of Medicine, Houston, Texas, USA. 16. Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas, USA. 17. Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA. 18. Ospedale del Cuore Fondazione Toscana "G. Monasterio", Massa, Italy.
Abstract
BACKGROUND: New technologies such as sutureless or rapid deployment prosthetic valves and access via minimally invasive incisions offer alternatives to traditional full-sternotomy aortic valve replacement (SAVR). However, a comprehensive comparison of these surgical techniques along with alternative valve prosthesis has not been completed. METHODS: Electronic databases were searched for studies comparing outcomes for SAVR, minimally invasive AVR (MiAVR), sutureless/rapid-deployment AVR (SuAVR) via full-sternotomy, or minimally invasive SuAVR (MiSuAVR) from their inception until September 2018. Early postoperative outcomes and follow-up data were included in a Bayesian network meta-analysis. RESULTS: Twenty-three studies with 8,718 patients were identified. Compared with standard SAVR, SuAVR had significantly lower incidence of postoperative AF [odds ratio (OR) 0.33, 95% confidence interval (CI): 0.14-0.79, P=0.013] and MiSuAVR greater requirement for postoperative permanent pacemaker (OR 2.27, 95% CI: 1.25-4.14, P=0.008). All sutureless/rapid-deployment procedures had reduced cardiopulmonary bypass and cross-clamp times, by a mean of 25.9 and 25.0 min, respectively. Hospital length of stay (LOS), but not intensive care LOS, was reduced for all groups (MiAVR -1.53 days, MiSuAVR -2.79 days, and SuAVR 3.37 days). A signal towards reduced early mortality, wound infections, and acute kidney injury was noted in both sutureless/rapid-deployment and minimally invasive techniques but did not achieve significance. Sutureless/rapid-deployment procedures had favourable survival and freedom from valve related reoperation, however follow-up times were short and demonstrated significant heterogeneity between intervention groups. CONCLUSIONS: Minimally invasive and sutureless techniques demonstrate equivalent early postoperative outcomes to SAVR and may reduce ventilation time, hospital LOS and postoperative atrial fibrillation (POAF) burden. 2020 Annals of Cardiothoracic Surgery. All rights reserved.
BACKGROUND: New technologies such as sutureless or rapid deployment prosthetic valves and access via minimally invasive incisions offer alternatives to traditional full-sternotomy aortic valve replacement (SAVR). However, a comprehensive comparison of these surgical techniques along with alternative valve prosthesis has not been completed. METHODS: Electronic databases were searched for studies comparing outcomes for SAVR, minimally invasive AVR (MiAVR), sutureless/rapid-deployment AVR (SuAVR) via full-sternotomy, or minimally invasive SuAVR (MiSuAVR) from their inception until September 2018. Early postoperative outcomes and follow-up data were included in a Bayesian network meta-analysis. RESULTS: Twenty-three studies with 8,718 patients were identified. Compared with standard SAVR, SuAVR had significantly lower incidence of postoperative AF [odds ratio (OR) 0.33, 95% confidence interval (CI): 0.14-0.79, P=0.013] and MiSuAVR greater requirement for postoperative permanent pacemaker (OR 2.27, 95% CI: 1.25-4.14, P=0.008). All sutureless/rapid-deployment procedures had reduced cardiopulmonary bypass and cross-clamp times, by a mean of 25.9 and 25.0 min, respectively. Hospital length of stay (LOS), but not intensive care LOS, was reduced for all groups (MiAVR -1.53 days, MiSuAVR -2.79 days, and SuAVR 3.37 days). A signal towards reduced early mortality, wound infections, and acute kidney injury was noted in both sutureless/rapid-deployment and minimally invasive techniques but did not achieve significance. Sutureless/rapid-deployment procedures had favourable survival and freedom from valve related reoperation, however follow-up times were short and demonstrated significant heterogeneity between intervention groups. CONCLUSIONS: Minimally invasive and sutureless techniques demonstrate equivalent early postoperative outcomes to SAVR and may reduce ventilation time, hospital LOS and postoperative atrial fibrillation (POAF) burden. 2020 Annals of Cardiothoracic Surgery. All rights reserved.
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