Surgical Sutureless and Sutured Aortic Valve Replacement in Low-risk Patients
| Autor: | Jae K. Oh, G. Michael Deeb, G. Chad Hughes, Steven J. Yakubov, Stephen E. Fremes, Michael J. Reardon, Thomas G. Gleason, Stuart J. Head, Thomas Modine, Jian Huang, J. Kevin Harrison, M. Erwin Tan, Ka Yan Lam, Pim A.L. Tonino |
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| Rok vydání: | 2022 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty medicine.medical_treatment Hemodynamics Global Health Prosthesis Design Risk Assessment Severity of Illness Index law.invention Transcatheter Aortic Valve Replacement Postoperative Complications Valve replacement Aortic valve replacement Randomized controlled trial Risk Factors law medicine Humans Stroke Aged business.industry Incidence Suture Techniques Aortic Valve Stenosis medicine.disease Sutureless Surgical Procedures Surgery Stenosis Treatment Outcome medicine.anatomical_structure Aortic Valve Female Permanent pacemaker Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 113:616-622 |
| ISSN: | 0003-4975 |
| Popis: | Randomized clinical trials have shown that transcatheter aortic valve replacement is noninferior to surgery in low surgical risk patients. We compared outcomes in patients treated with a sutured (stented or stentless) or sutureless surgical valve from the Evolut Low Risk Trial.The Evolut Low Risk Trial enrolled patients with severe aortic stenosis and low surgical risk. Patients were randomized to self-expanding transcatheter aortic valve replacement or surgery. Use of sutureless or sutured valves was at the surgeons' discretion.Six hundred eighty patients underwent surgical aortic valve implantation (205 sutureless, 475 sutured). The Valve Academic Research Consortium-2 30-day safety composite endpoint was similar in the sutureless and sutured group (10.8% vs 11.0%, P = .93). All-cause mortality between groups was similar at 30 days (0.5% vs 1.5%, P = .28) and 1 year (3.3% vs 2.6%, P = .74). Disabling stroke was also similar at 30 days (2.0% vs 1.5%, P = .65) and 1 year (2.6% vs 2.2%, P = .76). Permanent pacemaker implantation at 30 days was significantly higher in the sutureless compared with the sutured group (14.4% vs 2.9%, P.001). Aortic valve-related hospitalizations occurred more often at 1 year with sutureless valves (9.1% vs 5.1%, P = .04). Mean gradients 1 year after sutureless and sutured aortic valve replacement were 9.9 ± 4.2 versus 11.7 ± 4.7 mm Hg (P.001).Among low-risk patients, sutureless versus sutured valve use did not demonstrate a benefit in terms of 30-day complications and produced marginally better hemodynamics but with an increased rate of pacemaker implantation and valve-related hospitalizations. |
| Databáze: | OpenAIRE |
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