Clinical and Echocardiographic Outcomes of Sutureless vs. Transcatheter Aortic vs. Sutured Bioprosthesis Valves for Aortic Valve Replacement: A Systematic Review of Medical Literature

Aleksander D, Gianluigi B, Ali Fatehi H, Matteo C, Giulia Elena M, Serge S, Haxhire K, Marjela P, Altin V, Bruno C, Beatrice B, Francesco C, Massimo B, Marco G, Aaron S, Asher F, Maria Therese S and Nitin G

Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Canada Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, USA St. Michael’s Hospital, University of Toronto, Canada Department of Cardiac Sciences, Section of Cardiac Surgery, Libin Cardiovascular Institute, Cumming School of Medicine, Canada Department of Cardiology, Le Scotte Hospital, University of Siena, Italy Department of Cardiac Surgery, Mother Teresa Hospital, University of Tirana, Albania Department of Experimental and Clinical Medicine, University of Florence, Italy Department of Cardiac Surgery, University of Padua, Italy

^*Correspondance to: Aleksander Dokollari 

 PDF  Full Text DOI: 10.25107/2474-1647.3674

Abstract

Objective: To compare the clinical and echocardiographic outcomes of Aortic Valve Replacement (AVR) with Sutureless Bioprosthesis (SU-AVR) vs. Transcatheter Aortic Valve Replacement (TAVR) vs. Sutured Bioprosthesis (SB). Methods: A scoping review was conducted using a comprehensive search strategy from multiple databases (Medline, Embase, Cochrane Central Register of Controlled Clinical Trials). Two independent reviewers screened all abstracts and full texts according to predefined inclusion and exclusion criteria. Results: Thirty-two studies were included in the analysis. Thirty-day mortality ranged from 0% to 5.8% for sutureless and 0% to 9.8% for TAVR. The TAVR group had higher rates of moderate/severe Paravalvular Leak (PVL) (sutureless 0%-19.4% vs. TAVR 1.6%-53.5%), Permanent Pacemaker Implantation (PPI) (sutureless 0%-14.5% vs. TAVR 0%-25.5%), stroke (sutureless 0%-4.8% vs. TAVR 0%-5.8%), and Myocardial Infarction (MI) (sutureless 0% vs. TAVR 0%-3.5%). Compared to other SB, mortality ranged from 0% to 6.4% for sutureless and 0% to 5.9% for SB. Incidence of PVL (sutureless 1%-19.4% vs. SB 0%-1%), PPI (sutureless 2%-10.7% vs. SB 1.8%-8.5%), stroke (sutureless 0%-3.7% vs. SB 1.8%-7.3%) and MI (sutureless 0%-7.8% vs. SB 0%-4.3%) were comparable. Patients with bicuspid aortic valves demonstrated a mortality rate of 0% to 4% and PVL incidence of 0% to 2.3%. Long-term survival was 96.7% to 98.6%. Studies also show that sutureless valves are more cost-effective compared to TAVR. Conclusion: Sutureless bioprosthesis is a suitable alternative to surgical AVR due to its favorable hemodynamics, reduced implantation time leading to reduced cardiopulmonary bypass and aortic cross-clamp times, as well as shorter hospital length of stay.

Keywords

Sutureless; TAVR; Sutured; Long-term outcomes; Echocardiography; Pacemaker; Paravalvular leak

Cite the article

Aleksander D, Gianluigi B, Ali Fatehi H, Matteo C, Giulia Elena M, Serge S, et al. Clinical and Echocardiographic Outcomes of Sutureless vs. Transcatheter Aortic vs. Sutured Bioprosthesis Valves for Aortic Valve Replacement: A Systematic Review of Medical Literature. Clin Surg. 2023; 8: 3674..