Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies

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• 作者：Hisato Takagi ; MD ; PhD ; ^{kfgth973@ybb.ne.jp" class="auth_mail" title="E-mail the corresponding author} ; Takuya Umemoto ; MD ; PhD ; for the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
• 关键词：Meta-analysis ; Sutureless aortic valve replacement ; Transcatheter aortic valve replacement
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：67
• 期：6
• 页码：504-512
• 全文大小：1856 K

文摘

To determine which improves clinical outcomes more, sutureless (including rapid-deployment) aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of comparative studies.

Methods

MEDLINE and EMBASE were searched through June 2015 using Web-based search engines (PubMed and OVID). Studies considered for inclusion met the following criteria: the design was a comparative study; the study population included patients with severe aortic valve stenosis, patients were assigned to sutureless AVR versus TAVI; and main outcomes included at least early (in-hospital or 30-day) all-cause mortality.

Results

Of 87 potentially relevant articles screened initially, no randomized controlled trials and 7 observational comparative studies of sutureless AVR versus TAVI (enrolling a total of 945 patients) were identified and included. The first pooled analysis demonstrated a statistically significant reduction in mortality with sutureless AVR over TAVI [2.5% versus 7.3%; odds ratio (OR), 0.33; 95% confidence interval (CI), 0.16 to 0.69; p = 0.003; risk difference (RD), −5.23%; 95% CI, −8.12% to −2.33%; p = 0.0004]. The second pooled analyses demonstrated no statistically significant difference in bleeding complications, acute kidney injury, and conduction disturbance between sutureless AVR and TAVI. The third pooled analysis demonstrated a statistically significant reduction in paravalvular aortic regurgitation (AR) with sutureless AVR over TAVI (3.5% versus 33.2%; OR, 0.09; 95% CI, 0.05 to 0.16, p < 0.00001; MD, −22.56%; 95% CI, −36.59% to −8.53%; p = 0.002).

Conclusions

Compared with TAVI, sutureless AVR may be associated with a reduction in early mortality and postoperative paravalvular AR.