초록접수 현황
| 17F-219 | 구연 발표 |
Systematic Review and Meta-Analysis of Rapid Deployment Versus Conventional Aortic Valve Replacement
Suk Ho Sohn, Kyung-Hwan Kim, Myoung-Jin Jang, Ho Young Hwang
Department of Thoracic and Cardiovascular Surgery, Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Purpose : This meta-analysis was conducted to compare early and mid-term outcomes of AVR using RD valves (RDAVR group) with AVR using conventional bioprosthesis (CAVR group).
Methods : Studies were searched using 5 online database. Primary outcomes were aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times, incidence of paravalvular leak, and complete atrioventricular block requiring permanent pacemaker insertion. Secondary outcomes included early and mid-term mortality. Subgroup analyses were performed according to the type of RDAVR for each outcome.
Results : After reviewing 29 full-texts out of 2,046 searched studies, 21 articles including 2,785 patients (RDAVR group=1,297 patients, CAVR group=1,488 patients) were selected. Pooled analyses showed that ACC and CPB times were significantly shorter in RDAVR than CAVR groups (mean difference [95% confidence interval (CI)]=-26.34 [-31.86, -20.82] and -25.33 [-30.79, -19.87], respectively). Pooled risk ratios of any paravalvular leak and permanent pacemaker insertion were significantly higher in RDAVR group than CAVR group (Risk ratio [95% CI]=2.43 [1.37, 4.31] and 2.01 [1.42, 2.84], respectively). Subgroup analyses demonstrated that the risk of any paravalvular leak is significantly different according to the RDAVR types and risk of bias in each study. The risks of early and mid-term mortality were not significantly different between the 2 groups (early mortality=0.88 [0.54, 1.43] and mid-term all-cause mortality mortality=0.93 [0.70, 1.22]).
Conclusion : RDAVR has a benefit of 25-minute decrease in ACC time without increase in early and mid-term mortality compared to CAVR. Risks of paravalvular leak and permanent pacemaker insertion should be considered in the clinical decision of using RDAVR.
Methods : Studies were searched using 5 online database. Primary outcomes were aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times, incidence of paravalvular leak, and complete atrioventricular block requiring permanent pacemaker insertion. Secondary outcomes included early and mid-term mortality. Subgroup analyses were performed according to the type of RDAVR for each outcome.
Results : After reviewing 29 full-texts out of 2,046 searched studies, 21 articles including 2,785 patients (RDAVR group=1,297 patients, CAVR group=1,488 patients) were selected. Pooled analyses showed that ACC and CPB times were significantly shorter in RDAVR than CAVR groups (mean difference [95% confidence interval (CI)]=-26.34 [-31.86, -20.82] and -25.33 [-30.79, -19.87], respectively). Pooled risk ratios of any paravalvular leak and permanent pacemaker insertion were significantly higher in RDAVR group than CAVR group (Risk ratio [95% CI]=2.43 [1.37, 4.31] and 2.01 [1.42, 2.84], respectively). Subgroup analyses demonstrated that the risk of any paravalvular leak is significantly different according to the RDAVR types and risk of bias in each study. The risks of early and mid-term mortality were not significantly different between the 2 groups (early mortality=0.88 [0.54, 1.43] and mid-term all-cause mortality mortality=0.93 [0.70, 1.22]).
Conclusion : RDAVR has a benefit of 25-minute decrease in ACC time without increase in early and mid-term mortality compared to CAVR. Risks of paravalvular leak and permanent pacemaker insertion should be considered in the clinical decision of using RDAVR.
책임저자: Ho Young Hwang
Department of Thoracic and Cardiovascular Surgery, Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
발표자: Suk Ho Sohn, E-mail : xsshssx@gmail.com