Minimally Invasive Aortic Valve Replacement with Sutureless Valves: Results From an International Prospective Registry

Glauber, Mattia; Bacco, Lorenzo Di; Cuenca, José; Bartolomeo, Roberto Di; Baghai, Max; Žáková, Daniela; Fischlein, Theodor; Troise, Giovanni; Viganò, Giorgio; Solinas, Marco

doi:10.1177/1556984519892585

Cited by 33 publications

(69 citation statements)

References 43 publications

(77 reference statements)

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“…The included studies also inconsistently reported loss to follow-up. Only one study (14) reported other important outcomes such as total length of stay and length of stay in intensive care. The observational nature of all included studies, and therefore lack of randomization and blinding, present an inherent source of bias in this study.…”

Section: Discussionmentioning

confidence: 99%

“…The weighted mean follow-up period of all four studies was 2.2 years. All included studies reported mean pressure gradients (MPG) at 5 years postoperatively, whilst two (11,12) and three (11,12,14) studies also reported peak pressure gradient (PPG) and effective orifice area (EOA), respectively. Quality assessment of each study using the GRADE system is seen in Table 1 (7).…”

Section: Quality Of Studiesmentioning

confidence: 99%

“…Minimally invasive techniques are greatly facilitated by the design of these valves in addition to low rates of reoperation, which make these valves an important addition to surgical AVR technologies (5,14).…”

Section: Utz Kappert Manuel Wilbringmentioning

confidence: 99%

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Long-term outcomes of sutureless and rapid-deployment aortic valve replacement: a systematic review and meta-analysis

Williams

Flynn

Mamo

et al. 2020

Ann Cardiothorac Surg

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Background: Sutureless and rapid-deployment aortic valve replacement (SURD-AVR) has become a prominent area of research as the medical community evaluate its place amongst other aortic valve interventions. The main advantages of SURD-AVR established to date are the reduced cross-clamp and cardiopulmonary bypass (CPB) times, as well as facilitating minimally invasive surgery in high-risk surgical patients. This current systematic review and meta-analysis, to our knowledge, is the first focusing on longterm outcomes regarding safety, efficacy and durability of SURD-AVR from available current literature. Methods: A literature search via six electronic databases was performed from their inception to November 2019. Inclusion criteria for this systematic review included survival and postoperative echocardiographic outcomes greater than five years in patients who underwent SURD-AVR with either Perceval or Intuity valves. Studies were identified and data extracted by two independent reviewers. Long-term survival outcomes were aggregated using digitized Kaplan-Meier curves where available. Results: After applying predefined inclusion and exclusion criteria, four studies were identified for review. All four studies were observational and in total reported data for 1,998 patients. Almost half (42.4%) of patients underwent SURD-AVR via full sternotomy, with almost one third (30.1%) also undergoing concomitant cardiac procedures. Aggregate overall survival rates at 1-, 2-, 3-, and 5-year follow-up were 94.9%, 91.2%, 89.0%, and 84.2%, respectively. Incidence of strokes (4.8%), severe paravalvular leaks (PVLs) (1.5%) and permanent pacemaker (PPM) insertion (8.2%) at up to 5-year follow-up were acceptable. At 5-year followup hemodynamic outcomes were also acceptable for mean pressure gradient (MPG) (range, 8.8-13.6 mmHg), peak pressure gradient (PPG) (range, 18.9-21.1 mmHg) and effective orifice area (EOA) (range, 1.5-1.8 cm 2). Conclusions: Evaluation of the evidence reporting long-term outcomes of SURD-AVR suggests that it is a safe procedure for AVR with low rates of complications. Long-term outcomes presented in this review show that not only does SURD-AVR have acceptable survival rates, but also good hemodynamic performance at 5-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Quality Of Studiesmentioning

confidence: 99%

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Long-term outcomes of sutureless and rapid-deployment aortic valve replacement: a systematic review and meta-analysis

Williams

Flynn

Mamo

et al. 2020

Ann Cardiothorac Surg

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“…To date, few studies report the outcomes of SURD valve used in MICS. In the SURE registry, an international registry reporting the results of 480 MIAVR (MS and RAT) patients treated with sutureless valves (Figure 9) with a mean preoperative EuroSCORE I of 7.9% (52), no conversions to median sternotomy are reported and mortality at 30 days was 0.4%. A sutureless valve was implanted successfully in 98% of patients and at five years mean survival rate was 91.5% and freedom from valve related reoperation was 96.2%.…”

Section: Commentmentioning

confidence: 99%

Minimally invasive aortic valve surgery

Bacco¹,

Miceli²,

Glauber³

2021

J Thorac Dis

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Since their introduction, it has been demonstrated that minimally invasive aortic valve replacement (MIAVR) approaches are safe and effective for the treatment of aortic valve diseases. To date, the main advantage of these approaches is represented by the reduced surgical trauma, with a subsequent reduced complication rate and faster recovery. This makes such approaches an appealing choice also for frail patients [obese, aged, chronic obstructive pulmonary disease (COPD)]. The standardization of the minimally invasive techniques, together with the implementation of preoperative workup and anesthesiological intraand post-operative care, led to an amelioration of surgical results and reduction of surgical times. Moreover, the improvement of surgical technology and the introduction of new devices such as sutureless and rapid deployment (SURD) valves, has helped the achievement of comparable results to traditional surgery. However, transcatheter technologies are nowadays more and more important in the treatment of aortic valve disease, also in low risk patients. For this reason surgeons should put new efforts for further reducing the surgical trauma in the future, even taking inspiration from other disciplines. In this review, we aim to present a review of literature evidences regarding minimally invasive treatment of aortic diseases, also reflecting our personal experience with MIAVR techniques. This review could represent a tool for a well-structured patient assessment and preoperative planning, in order to safely carrying out an MIAVR procedure with satisfactory outcomes.

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“…AVR, full sternotomy aortic valve replacement; MiAVR, minimally invasive AVR; SuAVR, sutureless AVR; MiSuAVR, minimally invasive sutureless AVR. Graphs by column Graphs by column (38,39). This may be due to a greater focus on procedural modifications that reduce the incidence of conduction system injury or improved patient selection.…”

Section: Study 5 Study 15mentioning

confidence: 99%

Aortic valve replacement using stented or sutureless/rapid deployment prosthesis via either full-sternotomy or a minimally invasive approach: a network meta-analysis

Woldendorp¹,

Doyle²,

Bannon³

et al. 2020

Ann Cardiothorac Surg

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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.

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Minimally Invasive Aortic Valve Replacement with Sutureless Valves: Results From an International Prospective Registry

Cited by 33 publications

References 43 publications

Long-term outcomes of sutureless and rapid-deployment aortic valve replacement: a systematic review and meta-analysis

Long-term outcomes of sutureless and rapid-deployment aortic valve replacement: a systematic review and meta-analysis

Minimally invasive aortic valve surgery

Aortic valve replacement using stented or sutureless/rapid deployment prosthesis via either full-sternotomy or a minimally invasive approach: a network meta-analysis

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