Does Quicker Mean Better? Comparison of Rapid Deployment Versus Conventional Aortic Valve Replacement
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Updated: Dec 10, 2025
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Yi Lu1, Jianfang Wang1, Zexin Chen2
1Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine.
Insights
Rapid deployment aortic valve replacement (RDAVR) shows comparable survival to conventional methods. While RDAVR reduces transfusion needs and postoperative atrial fibrillation, it increases the likelihood of requiring a permanent pacemaker.
Area of Science:
- Cardiovascular Surgery
- Medical Technology Assessment
- Thoracic Surgery
Background:
- Aortic valve replacement is a critical procedure for severe aortic stenosis.
- Rapid deployment aortic valve replacement (RDAVR) aims to shorten surgical times compared to conventional bio prosthetic aortic valve replacement (CAVR).
- Clinical outcomes and complication rates of RDAVR versus CAVR require comprehensive evaluation.
Purpose of the Study:
- To compare clinical outcomes between rapid deployment aortic valve replacement (RDAVR) and conventional bio prosthetic aortic valve replacement (CAVR).
- To assess differences in mortality, procedural times, and postoperative complications.
Main Methods:
- Meta-analysis of randomized controlled trials and propensity score-matched studies.
- Literature search conducted up to August 2018.
- Primary outcomes: hospital and 1-year mortality. Secondary outcomes: aortic cross-clamp time, cardiopulmonary bypass time, and postoperative complications.
Main Results:
- No significant difference in hospital or 1-year mortality between RDAVR and CAVR.
- RDAVR significantly reduced aortic cross-clamp and cardiopulmonary bypass times.
- RDAVR was associated with a doubled risk of permanent pacemaker implantation but reduced postoperative atrial fibrillation and blood transfusion requirements.
Conclusions:
- Hospital and 1-year survival rates are comparable between RDAVR and CAVR.
- RDAVR offers benefits in reduced operative times, lower blood transfusion needs, and decreased postoperative atrial fibrillation.
- Increased pacemaker implantation rates necessitate careful consideration when choosing RDAVR.
Abstract:
The aim of this meta-analysis was to compare the clinical outcomes in patients who underwent rapid deployment aortic valve replacement (RDAVR) and conventional bio prosthetic aortic valve replacement (CAVR).We performed a literature search by August 2018. The primary outcomes were hospital and 1-year mortality, and the secondary endpoints included the aortic cross-clamp (ACC), cardiopulmonary bypass (CPB) time, and postoperative and valve-related complications.Two randomized controlled trials and 13 propensity score-matched studies were included. There was no difference between RDAVR and CAVR in hospital mortality (2.5% versus 2.1%; risk ratio (RR) 1.16 [95% confidence interval (CI) 0.80-1.68]) or 1-year mortality (2.9% versus 4.1%; RR 0.69 [95% CI 0.34-1.34]). RDAVR significantly reduced the ACC time ( (mean difference (MD) -24.33 [95% CI -28.35 to -20.32]) and CPB time (MD -21.51 [95% CI -22.83 to -20.20]). The pooled analysis showed that RDAVR doubled the occurrence of permanent pacemaker implantation (8.6% versus 4.3%; RR 2.05 [95% CI 1.62-2.60]). Meanwhile, the blood transfusion amount (MD -1.54 [95% CI -2.22 to -0.86]) and postoperative atrial fibrillation (POAF) occurrence (RR 0.83 [95% CI 0.69-0.99]) was reduced. The difference of paravalvular leakage frequency between RDAVR and CAVR was marginal (RR 1.77 [95% CI 1.00-3.17]; P = 0.05). Furthermore, RDAVR was related to larger valves (MD 0.70 cm [95% CI 0.33-1.07]) and lower mean pressure gradients (MD -1.93 mmHg [95% CI -3.58 to -0.28]).The hospital and 1-year survival rates between RDAVR and CAVR are comparable. RDAVR reduces POAF occurrence and blood transfusion but is associated with a higher occurrence of pacemaker implantation.
