Sutureless and rapid deployment versus sutured aortic valve replacement: a propensity-matched comparison from the Sutureless and Rapid Deployment International Registry

Author:

Berretta Paolo1ORCID,Andreas Martin2ORCID,Meuris Bart3,Langenaeken Tom3,Solinas Marco4,Concistrè Giovanni4,Kappert Utz5ORCID,Arzt Sebastian5,Santarpino Giuseppe678,Nicoletti Anna7,Misfeld Martin910111213,Borger Michael A9ORCID,Savini Carlo14ORCID,Gliozzi Gregorio14,Albertini Alberto15ORCID,Mikus Elisa15,Fischlein Theodor8ORCID,Kalisnik Jurij8,Martinelli Gian Luca16,Cotroneo Attilio16,Mignosa Carmelo17,Ricasoli Alessandro17,Yan Tristan1018ORCID,Laufer Ghunter2,Di Eusanio Marco118

Affiliation:

1. Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche , Ospedali Riuniti, Ancona, Italy

2. Department of Cardiac Surgery, Medical University of Vienna , Vienna, Austria

3. Departement of Cardiovascular Disease , KU Leuven, Belgium

4. Pasquinucci Heart Hospital , Massa, Italy

5. Department of Cardiac Surgery, University Heart Centre Dresden , Dresden, Germany

6. Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro , Italy

7. Department of Cardiac Surgery, ‘Città di Lecce’ Hospital, GVM Care & Research , Lecce, Italy

8. Cardiovascular Center, Paracelsus Medical University , Nuremberg, Germany

9. University Department for Cardiac Surgery, Leipzig Heart Center , Leipzig, Germany

10. Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital , Sydney, Australia

11. Institute of Academic Surgery, RPAH , Sydney, Australia

12. The Baird Institute of Applied Heart and Lung Surgical Research , Sydney, Australia

13. Sydney Medical School, University of Sydney , Australia

14. Cardiac Surgery Department, Sant’Orsola Malpighi Hospital, University of Bologna , Italy

15. Cardiovascular Surgery Department, Maria Cecilia Hospital GVM Care & Research , Cotignola, Italy

16. Cardiac Surgery Department, IRCCS Multimedica , Milano, Italy

17. Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria ‘policlinico-San Marco’ , Catania, Italy

18. The Collaborative Research (CORE) Group

Abstract

Abstract OBJECTIVES To compare procedural and in-hospital outcomes of patients undergoing sutureless (Perceval, Livanova PLC, London, UK) and rapid deployment (Intuity Elite, Edwards Lifesciences, Irvine, CA, USA) aortic valve replacement (group 1) versus sutured aortic valve replacement (group 2). METHODS Patients receiving isolated aortic valve replacement between 2014 and 2020 were analysed using data from the Sutureless and Rapid Deployment International Registry. Patients in group 1 and group 2 were propensity-score matched in a 1:1 ratio. RESULTS A total of 7708 patients were included in the study. After matching, 2 groups of 2643 each were created. Patients in group 1 were more likely to undergo minimally invasive approaches and were associated with shorter operative times when compared with group 2. Overall in-hospital mortality was similar between groups. While an increased risk of stroke was observed in group 1 in the first study period (2014–2016; relative risk 3.76, P < 0.001), no difference was found in more recent year period (relative risk 1.66, P = 0.08; P for heterogeneity 0.003). Group 1 was associated with reduced rates of postoperative low cardiac output syndrome, atrial fibrillation and mild aortic regurgitation. New pacemaker implant was three-fold higher in group 1. CONCLUSIONS Our findings showed significant differences in procedural and clinical outcomes between the study groups. These results suggest that sutureless and rapid deployment aortic valve replacement should be considered as part of a comprehensive valve programme. The knowledge of the respective post-aortic valve replacement benefits for different valve technologies may result in patient-tailored valve selection with improved clinical outcomes.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery

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