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Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: A meta-analysis.

OBJECTIVES: This meta-analysis was conducted to compare the early and follow-up outcomes of aortic valve replacement using rapid deployment or sutureless (RD) valves (RDAVR group) with aortic valve replacement using conventional bioprostheses (CAVR group).

METHODS: A literature search of 5 online databases was conducted. The primary outcomes were postoperative complications and the secondary outcomes included the aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times and early mortality and all-cause mortality during follow-up.

RESULTS: Twenty-one articles (RDAVR group = 1297 patients; CAVR group = 1488 patients) were selected. The pooled analyses showed that the ACC and CPB times were significantly shorter in the RDAVR group than in the CAVR group (mean difference, -26.34; 95% confidence interval [CI], -31.86 to -20.82 and mean difference, -25.33; 95% CI, -30.79 to -19.87, respectively). The pooled risk ratios (RRs) of any paravalvular leak and permanent pacemaker (PPM) insertion were significantly higher in the RDAVR group than in the CAVR group (RR, 2.32; 95% CI, 1.53-3.51 and RR, 2.08; 95% CI, 1.49-2.90, respectively). The pooled analysis showed that the risk of a paravalvular leak grade ≥2 in the RDAVR group did not significantly differ between the RDAVR and CAVR groups (RR, 2.05; 95% CI, 0.71-5.93). The risk of PPM insertion remained significant when only studies reporting adjusted outcomes were pooled. The risks of other postoperative complications, early mortality, and all-cause mortality during follow-up were not significantly different between the RDAVR and CAVR groups.

CONCLUSIONS: RDAVR is associated with significantly shorter ACC and CPB times than CAVR, although this difference did not translate into improved postoperative outcomes, early mortality, and all-cause mortality during follow-up. Care might be needed when implanting RD valves because they are associated with a higher incidence of PPM insertion, regardless of the RD valve type.

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