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Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies.

Abstract：

OBJECTIVES:To determine which improves clinical outcomes more, sutureless (including rapid-deployment) aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of comparative studies. METHODS:MEDLINE and EMBASE were searched through June 2015 using Web-based search engines (PubMed and OVID). Studies considered for inclusion met the following criteria: the design was a comparative study; the study population included patients with severe aortic valve stenosis, patients were assigned to sutureless AVR versus TAVI; and main outcomes included at least early (in-hospital or 30-day) all-cause mortality. RESULTS:Of 87 potentially relevant articles screened initially, no randomized controlled trials and 7 observational comparative studies of sutureless AVR versus TAVI (enrolling a total of 945 patients) were identified and included. The first pooled analysis demonstrated a statistically significant reduction in mortality with sutureless AVR over TAVI [2.5% versus 7.3%; odds ratio (OR), 0.33; 95% confidence interval (CI), 0.16 to 0.69; p=0.003; risk difference (RD), -5.23%; 95% CI, -8.12% to -2.33%; p=0.0004]. The second pooled analyses demonstrated no statistically significant difference in bleeding complications, acute kidney injury, and conduction disturbance between sutureless AVR and TAVI. The third pooled analysis demonstrated a statistically significant reduction in paravalvular aortic regurgitation (AR) with sutureless AVR over TAVI (3.5% versus 33.2%; OR, 0.09; 95% CI, 0.05 to 0.16, p<0.00001; MD, -22.56%; 95% CI, -36.59% to -8.53%; p=0.002). CONCLUSIONS:Compared with TAVI, sutureless AVR may be associated with a reduction in early mortality and postoperative paravalvular AR.

journal_name

J Cardiol

journal_title

Journal of cardiology

authors

Takagi H,Umemoto T,ALICE (All-Literature Investigation of Cardiovascular Evidence) Group.

doi

10.1016/j.jjcc.2015.09.009

subject

Has Abstract

pub_date

2016-06-01 00:00:00

pages

504-12

issue

eissn

0914-5087

issn

1876-4738

pii

S0914-5087(15)00296-8

journal_volume

pub_type

杂志文章,meta分析

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Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies.