Key result
Perceval sutureless AVR increases pacemaker risk ~150% versus conventional valves while reducing cross-clamp time.
Why the study?
Perceval sutureless valves have gained popularity, but whether this implant performs superior to traditional sutured prostheses remains unclear.
Does Perceval sutureless valve replacement improve clinical outcomes or reduce surgical times compared to conventional sutured valves in patients with aortic valve disease?
Meta-Analysis (n=5,215)
Does Perceval sutureless valve replacement improve clinical outcomes or reduce surgical times compared to conventional sutured valves in patients with aortic valve disease?
Effect estimate: OR 2.50 (95% CI 1.88 to 3.33)
p-value: p=<0.00001
Perceval sutureless aortic valves significantly reduce surgical cross-clamp and bypass times but are associated with a 2.5-fold increased risk of postoperative pacemaker implantation compared to conventional sutured valves.
May warrant caution for pacemaker risk in patient selection; confirms shorter cross-clamp times versus conventional valves.
PURPOSE: Perceval sutureless valves have gained popularity. Whether this implant performs superior to the traditional sutured prosthesis remains unclear. This meta- analysis compared the Perceval implants versus the sutured conventional valves for aortic valve replacement (AVR). METHODS: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were accessed: PubMed, Google Scholar, Web of Science, Scopus, and EMBASE. All clinical investigations comparing Perceval versus the conventional prostheses for AVR were considered. RESULTS: The Perceval group demonstrated higher rate of pacemaker implantation (P <0.00001). Aortic cross-clamp (ACC) time (P <0.00001) and cardiopulmonary bypass (CPB) time (P <0.00001) were shorter in the Perceval group. Similarity was found in mean and peak pressure gradient (P = 0.8 and P = 0.2, respectively), mean aortic valve area (P = 0.3), length of intensive care unit (P = 0.4) and hospital stay (P = 0.2), rate of revision (P = 0.11), hemorrhages (P = 0.05), paravalvular leak (P = 0.3), cerebrovascular complication (P = 0.7), and early mortality (P = 0.06). CONCLUSION: Given the shorter ACC time and CPB time, Perceval AVR can be an alternative in high-risk patients. The higher rate of pacemaker implantation following Perceval may limit its routine implantation.
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Colarossi et al. (2022) conducted a meta-analysis in Aortic valve disease (n=5,215). Perceval sutureless valve vs. Conventional sutured valve was evaluated on Pacemaker implantation (OR 2.50, 95% CI 1.88 to 3.33, p=<0.00001). Perceval sutureless aortic valve replacement significantly increased the risk of pacemaker implantation (OR 2.50) and reduced aortic cross-clamp time compared to conventional sutured valves.
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