A Meta-Analysis of Sutureless or Rapid-Deployment Aortic Valve Replacement

Objective To summarize the safety of sutureless or rapid-deployment aortic valve replacement (AVR), we performed a systematic review and meta-analysis of single-arm studies. Methods MEDLINE and EMBASE were searched through December 2014. Studies considered for inclusion met the following criteria: the design was a single-arm study enrolling ≥50 participants; the study population consisted of patients undergoing sutureless/rapid-deployment AVR; and main outcomes included early (in-hospital or 30-day) mortality and/or overall survival. Results Of 250 potentially relevant articles screened initially, 11 eligible studies enrolling a total of 2,066 patients were identified and included. The Enable, Intuity, and Perceval bioprostheses were used in three, two, and six studies, respectively. Mean age of patients was 77.6 years, and 56.9% of patients were women. Mean logistic European System for Cardiac Operative Risk Evaluation I and II were 10.5 and 7.4%, respectively. Aortic cross-clamp times in overall patients, patients undergoing isolated AVR, those undergoing AVR with any concomitant procedures, and those undergoing AVR with coronary artery bypass grafting were 44.7, 41.9, 56.2, and 51.3 minutes, respectively. Arithmetic mean of early mortality was 2.6%, and fixed-effects combined early mortality was 3.2% (95% confidence interval, 2.5-4.2%). Arithmetic mean of 1-year survival was 89.7%, and fixed-effects combined 1-year mortality was 10.4% (9.0-12.1%). Conclusion Sutureless/rapid-deployment AVR is feasible and safe with approximate 3 and 10% of early and 1-year mortality, respectively. Large-size randomized controlled trials, however, are needed to determine whether sutureless/rapid-deployment AVR improves mortality compared with conventional AVR.