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

Michael L. Williams*, Campbell D. Flynn, Andrew A. Mamo, David H. Tian, Utz Kappert, Manuel Wilbring, Thierry Folliguet, Antonio Fiore, Antonio Miceli, Augusto D'Onofrio, Giorgia Cibin, Gino Gerosa, Mattia Glauber, Theodor Fischlein, Francesco Pollari

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    26 Citations (Scopus)
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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 long-term 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 follow-up 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 cm2). 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.

    Original languageEnglish
    Pages (from-to)265-279
    Number of pages15
    JournalAnnals of Cardiothoracic Surgery
    Issue number4
    Publication statusPublished - Jul 2020

    Bibliographical note

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    • Aortic valve replacement (AVR)
    • Rapid-deployment
    • Sutureless
    • Systematic review


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