Sutureless valves versus aortic root enlargement for aortic valve replacement in small aortic annulus: A systematic review and pooled analysis

被引:3
|
作者
Agarwal, Rajat [1 ,6 ]
Arnav, Amiy [2 ]
Ranjan, Ashis [3 ]
Mudgal, Shiv [4 ]
Singh, Dharmendra [5 ]
机构
[1] All India Inst Med Sci AIIMS, Dept Cardiothorac Surg, Deoghar, Jharkhand, India
[2] All India Inst Med Sci AIIMS, Dept Surg Oncol, Deoghar, Jharkhand, India
[3] All India Inst Med Sci AIIMS, Dept Cardiol, Deoghar, Jharkhand, India
[4] All India Inst Med Sci AIIMS, Coll Nursing, Deoghar, Jharkhand, India
[5] All India Inst Med Sci AIIMS, Dept Radiotherapy, Deoghar, Jharkhand, India
[6] AIIMS Deoghar, Deoghar 814152, Jharkhand, India
关键词
Aortic valve surgery; aortic root enlargement; sutureless valve; small aortic annulus; LATE OUTCOMES; RAPID-DEPLOYMENT; IMPLANTATION; PROSTHESIS; STENOSIS; MULTICENTER; EXPERIENCE; TIME;
D O I
10.1177/02184923231187055
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Very few studies provide direct comparisons between aortic root enlargement and sutureless valve implantation in patients with a small aortic annulus who underwent aortic valve replacement. This study aims to provide comparative outcomes between the two in such a subset of patients, through a systematic review and pool analysis. Methods The PubMed, Scopus and Embase databases were searched using the appropriate terms. The data from original articles mentioning aortic root enlargement and sutureless valves in a single or comparative study with another group of patients with a small aortic annulus were pooled and analyzed using descriptive statistics. Results Both cardiopulmonary bypass (68.4 vs. 125.03 min, p < 0.001) and aortic cross-clamp times were significantly shorter in the sutureless valve group, along with a concomitantly higher number of minimally invasive surgeries. The incidence of permanent pacemaker implantation (9.76% vs. 3.16%, p < 0.00001), patient prosthesis mis-match and paravalvular leak was significantly higher in the sutureless valve group. In comparison, the incidence of re-exploration for bleeding was higher in the aortic root enlargement group (5.27% vs. 3.16%, p < 0.02). The two groups had no differences in the duration of hospital stays or mortality. Conclusions Sutureless valves demonstrated a comparable hemodynamic outcome with aortic root enlargement in patients with a small aortic annulus. In addition to this, it greatly facilitated minimally invasive surgery. However, the high incidence of pacemaker implantation is still a concern for the widespread recommendation of sutureless valves, especially in young patients with a small aortic annulus.
引用
收藏
页码:524 / 532
页数:9
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