Rapid deployment technology versus conventional sutured bioprostheses in aortic valve replacement

M. Yousuf Salmasi; Sruthi Ramaraju; Iqraa Haq; Ryan A. B. Mohamed; Taimoor Khan; F. Oezalp; George Asimakopoulos; Shahzad G. Raja

doi:10.1111/jocs.16223

January 14, 2022Journal of Cardiac SurgeryOpen Access

Rapid deployment technology versus conventional sutured bioprostheses in aortic valve replacement

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Why the study?

Despite the benefits of RDAVR, cAVR remains more commonly used for aortic stenosis, and randomized studies directly comparing both options are scarce.

Does rapid deployment aortic valve replacement compared to conventional sutured valves improve clinical and procedural outcomes in patients with aortic stenosis?

Structured PICO

Does rapid deployment aortic valve replacement compared to conventional sutured valves improve clinical and procedural outcomes in patients with aortic stenosis?

P

Population

10,381 participants with aortic stenosis pooled from 35 studies (1 randomized study, 1 registry study, 6 propensity-matched studies, and 28 observational studies)

I

Intervention

Rapid deployment aortic valve prostheses (RDAVR)

C

Comparator

Conventional sutured valves (cAVR)

O

Outcome

Operative mortality, stroke, or bleedinghard clinical

Rapid deployment aortic valve replacement reduces operative times and ICU length of stay compared to conventional sutured valves, but is associated with a significantly higher risk of pacemaker insertion and midterm paravalvular leak.

Implication

Supports RDAVR for shorter operative times yet cautions on pacemaker and leak risks; extends prior data with pooled evidence.

Abstract

OBJECTIVES: Despite the benefits of rapid deployment aortic valve prostheses (RDAVR), conventional sutured valves (cAVR) are more commonly used in the treatment for aortic stenosis. Given the paucity of randomized studies, this study aimed to synthesize available data to compare both treatment options. METHODS: A systematic search of Pubmed, OVID, and MEDLINE was conducted to retrieve comparative studies for RDAVR versus cAVR in the treatment of aortic stenosis. Out of 1773 returned titles, 35 papers were used in the final analysis, including 1 randomized study, 1 registry study, 6 propensity-matched studies, and 28 observational studies, incorporating a total of 10,381 participants (RDAVR n = 3686; cAVR n = 6310). RESULTS: Random-effects meta-analysis found no difference between the two treatment groups in terms of operative mortality, stroke, or bleeding (p > .05). The RDAVR group had reduced cardiopulmonary bypass (standardized mean difference [SMD]: -1.28, 95% confidence interval [CI]: [-1.35, -1.20], p < .001) and cross-clamp times (SMD: -1.05, 95% CI: [-1.12, -0.98], p < .001). Length of stay in the intensive care unit was also shorter in the RDAVR group (SMD: -0.385, 95% CI: [-0.679, -0.092], p = .010). The risk of pacemaker insertion was higher for RDAVR (odds ratio [OR]: 2.41, 95% CI: [1.92, 3.01], p < .001) as was the risk of paravalvular leak (PVL) at midterm follow-up (OR: 2.52, 95% CI: [1.32, 4.79], p = .005). Effective orifice area and transvalvular gradient were more favorable in RDAVR patients (p > .05). CONCLUSIONS: Despite the benefits of RDAVR in terms of reduced operative time and enhanced recovery, the risk of pacemaker insertion and midterm PVL remains a significant cause for concern.