Sutureless Perceval Aortic Valve Versus Conventional Stented Bioprostheses: Meta‐Analysis of Postoperative and Midterm Results in Isolated Aortic Valve Replacement

Meco, Massimo; Montisci, Andrea; Miceli, Antonio; Panisi, Paolo; Donatelli, Francesco; Cirri, Silvia; Ferrarini, Matteo; Lio, Antonio; Glauber, Mattia

doi:10.1161/jaha.117.006091

Cited by 88 publications

(112 citation statements)

References 36 publications

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“…Some advocate sutureless valves in patients with a small aortic root to allow the placement of a larger bioprosthesis and therefore avoid PPM 40. However, there is concern that sutureless valves may be associated with more conduction disorders and paravalvular leaks 40…”

Section: Prevention Of Ppmmentioning

confidence: 99%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

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Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.

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Section: Prevention Of Ppmmentioning

confidence: 99%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

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“…Sutureless valve is an alternative surgical adjunct that replaces the conventional prosthetic valve and boasts its reduced need for sutures, thereby minimizing CPB and AXT . Due to the design of sutureless valves, their implantation in AVR is positioned below the aortic annulus, which increases the risk of atrioventricular block . On the other hand, PVL is suspected to be an adverse outcome as a result of inadequate positioning and sizing of sutureless valves or incomplete annulus decalcification .…”

Section: Discussionmentioning

confidence: 99%

What is the safety and efficacy of the use of automated fastener in heart valve surgery?

et al. 2019

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Introduction: Cor-Knot automated fastener has been used as an adjunct in heart valve surgery to eliminate the need for manual tying during valve implantation. Although reduced operative time and facilitation for minimally invasive surgery are clear benefits, whether their use translates to improved patient outcome remains debatable. This study aims to review the safety and efficacy of automated fasteners in heart valve surgeries. Method: Specific searches were conducted via online medical databases (Pubmed, Embase, Ovid) between 1950 and June 2019. Longitudinal studies were included that provided operative parameters. Results: The initial literature search identified 3773 articles, but only eight met the inclusion criteria and were used for analysis: four studies related to aortic valve replacement (AVR), four related to mitral valve (MV) intervention (total n = 810). The meta-analysis revealed the significantly shorter aortic cross-clamp time in the Cor-knot group compared to manual tying, both in AVR and MV surgeries (P < .05). Cardiopulmonary bypass time was significantly shorter in the Cor-knot group when analyzing studies in MV surgery (weighted mean difference [WMD]: 110.0; 95% confidence interval: 12.3-207.7; P = .027) The use of Cor-Knot did not increase the risk of permanent pacemaker implantation, paravalvular leak, and 30-day mortality. The majority of studies reported no change in the length of intensive unit care and total hospital stay. Conclusion:We confirmed that the majority of existing literatures indicated the safety and intraoperative efficacy with automated fastener application. Nevertheless, there is currently no evidence to support automated fastened sutures can translate its intraoperative advantages to improved patient outcome. K E Y W O R D S aortic, automated fastener, clinical review, cor-knot, heart valves, mitral 1 | BACKGROUND Surgery for valvular heart disease is well-established and remains a superior treatment option for many valvular pathologies in many patient groups. Both replacement (with prosthetic valves) and repair Abbreviations: AS, aortic stenosis; AVR, aortic valve replacement; AXT, aortic cross-clamp time; CPB, cardiopulmonary bypass time; ICU, intensive care unit; LV, left ventricular; Mini-AVR, minimally invasive aortic valve replacement; Mini-MV repair, minimally invasive mitral valve repair; MR, mitral regurgitation; MV, mitral valve; PPI, permanent pacemaker implantation; PVL, paravalvular leak; TAVR, transcatheter aortic valve replacement. Lueh Chien and M. Yousuf Salmasi are Joint first authors.

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“…Hence, all the papers reporting techniques that could not be easily attributed to one of the two previously mentioned surgical techniques, or papers reporting different techniques (eg, chordal cutting or leaflets augmentation) were excluded. Included studies should contain data of the following outcomes: 30‐days all‐cause mortality and the outcomes described in the Valve Academic Research Consortium standardized endpoint definition 8 . Once full articles were retrieved, studies were further excluded if there was an overlap in patients with another study within the same analysis (in such case, the larger sample size of the two studies was selected).…”

Section: Methodsmentioning

confidence: 99%

“…Included studies should contain data of the following outcomes: 30-days all-cause mortality and the outcomes described in the Valve Academic Research Consortium standardized endpoint definition. 8 Once full articles were retrieved, studies were further excluded if there was an overlap in patients with another study within the same analysis (in such case, the larger sample size of the two studies was selected). Thus, whereas some patients could possibly have been included in both the controlled and uncontrolled study analyses, they were only included once in any given analysis.…”

Section: Data Extractionmentioning

confidence: 99%

Meta‐analysis of results of subvalvular repair for severe ischemic mitral regurgitation

et al. 2020

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Background and Aim of the Study The aim of this meta‐analysis was to compare short‐ and long‐term outcomes of patients undergoing mitral annuloplasty (MA) with or without papillary muscle surgery (PMS) for the treatment of ischemic mitral regurgitation (IMR). Methods A systematic review and meta‐analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement were performed. Results Nine studies met the inclusion criteria. This meta‐analysis identified 478 patients: 228 patients underwent MA alone and 250 patients underwent concomitant PMS. Early mortality was similar between two groups (odds ratio [OR] 1.14, 95% confidence interval [CI], 0.51‐2.53; P = .75). PMS was associated at follow‐up with a higher freedom from cardiac‐related events (P = .050); moreover, although both surgical techniques had a positive impact on ventricular remodeling, the PMS group showed a significant higher reduction of left ventricle end‐diastolic diameter (OR, 4.89, 95% CI, 2.77‐7.01; P < .001) and left ventricle end‐systolic diameter values (OR, 4.11, 95% CI, 1.98‐6.24; P < .001). Finally, PMS compared with MA alone was associated with a significant reduction of recurrent mitral regurgitation at follow‐up (OR, 3.25, 95% CI, 1.60‐6.59; P = .001). Conclusions This meta‐analysis demonstrated superiority in terms of ventricular remodeling of a combined approach encompassing PMS and MA over MA alone in IMR. Moreover, the association of subvalvular surgery with restrictive MA decreases the incidence of mitral regurgitation recurrence and cardiac‐related events at follow‐up.

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Sutureless Perceval Aortic Valve Versus Conventional Stented Bioprostheses: Meta‐Analysis of Postoperative and Midterm Results in Isolated Aortic Valve Replacement

Cited by 88 publications

References 36 publications

Patient-prosthesis mismatch following aortic valve replacement

Patient-prosthesis mismatch following aortic valve replacement

What is the safety and efficacy of the use of automated fastener in heart valve surgery?

Meta‐analysis of results of subvalvular repair for severe ischemic mitral regurgitation

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