Sutureless and rapid-deployment versus conventional bioprosthetic aortic valve replacement in patients with aortic stenosis: a systematic review and meta-analysis of randomised controlled trials

Abstract

Abstract Background Sutureless aortic valve replacement (SUAVR) has become an alternative to conventional bioprosthetic aortic valve replacement (CAVR) for the treatment of aortic stenosis. This procedure was designed to shorten surgery time, enable optimal valve insertion, and improve surgical outcomes. Purpose This study aimed to compare the clinical outcomes between SUAVR and CAVR for treating patients with aortic stenosis. Methods Systematic searches were conducted from the inception to December 2022, using 4 databases: PubMed, Scopus, Embase, and Web of Sciences. Randomised controlled trials comparing SUAVR versus CAVR were included for analyses. Data were extracted and analysed using predefined clinical outcomes. The revised Cochrane risk-of-bias tool for randomized trials version 2.0 was used to assess the quality of included RCTs. A meta-analysis with risk ratio (RR) or mean difference (MD) was performed to compare clinical outcomes such as aortic cross-clamp (ACC) time, cardiopulmonary bypass (CPB) time, mortality, and complications at 30 days and 1 year. Results The study included 4 articles with a total of 478 SUAVR and 485 CAVR patients. Compared to CAVR, SUAVR had a significantly shorter ACC time (MD -25.1 minutes, 95%CI -44.5 to -5.8, I2 =97%, p 0.01) and CPB time (MD -22.8 minutes, 95% CI -42.4 to -3.2, I2 =93%, p 0.02). There was no significant difference in mortality at 30-day (RR 1.04, 95%CI 0.34-3.15, I2 =0%, p 0.952) and 1-year follow-up (RR 1.08, 95%CI 0.56-2.06, I2 =0%, p 0.822). Complications including myocardial infarction, stroke, major bleeding, renal failure, and endocarditis, did not significantly differ between the two groups. However, permanent pacemaker implantation was significantly higher after SUAVR at 30 days (RR 3.25, 95%CI 1.81-5.84, I2 =0%, p <0.01) and 1 year (RR 2.97, 95%CI 1.71-5.16, I2 =0%, p <0.01). Conclusions SUAVR had significantly shorter ACC and CPB times than CAVR. SUAVR required more permanent pacemaker implantation than CAVR. Mortality and other complications were comparable between the two groups.