Queen's School of Medicine, Kingston, Ontario, Canada.
Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada.
J Card Surg. 2022 Oct;37(10):3355-3362. doi: 10.1111/jocs.16795. Epub 2022 Jul 28.
The objective of this scoping review is to describe the postoperative outcomes and complications of patients with bicuspid aortic valve (BAV) treated with sutureless or rapid-deployment prosthesis.
The use of sutureless and rapid-deployment prostheses is generally avoided in patients with BAV due to anatomical concerns and the elevated risk of para-prosthetic leaks. Multiple studies have reported the use of these prostheses into patients with BAV with varying degrees of success. The focus of this review is to consolidate the current available evidence on this topic.
A scoping review was conducted using a comprehensive search strategy in multiple databases (Medline, Embase, Cochrane Central Register of Controlled Clinical Trials) for relevant articles. All abstracts and full texts were screened by two independent reviewers according to predefined inclusion and exclusion criteria. Thirteen articles, including case reports and case series were ultimately included for analysis.
Of 1052 total citations, 44 underwent full text review and 13 (4 case reports, 6 retrospective analyses, and 3 prospective analyses) were included in the scoping review. Across all 13 studies, a total of 314 patients with BAV were used for data analysis. In sutureless and rapid-deployment prostheses, the mean postoperative aortic valvular gradients were less than 15 mmHg in all studies with mean postoperative aortic valvular areas all greater than 1.3 cm. There were 186 total complications for an overall complication rate of 59%. Individual complications included new onset atrial fibrillation (n = 65), required pacemaker insertion (n = 24), intraprosthetic aortic regurgitation (n = 20), new onset atrioventricular block (n = 18), and new onset paravalvular leakage (n = 10).
The use of sutureless and rapid deployment prostheses in patients with BAV showed comparable intraoperative and implantation success rates to patients without BAV. Postoperative complications from using these prostheses in patients with BAV included new onset atrial fibrillation, intraprosthetic aortic regurgitation, new onset atrioventricular block, and required pacemaker insertion. Various techniques have been described to minimize these complications in patients with BAV receiving sutureless or rapid deployment prostheses.
本综述旨在描述使用无缝线或快速部署假体治疗二叶式主动脉瓣（BAV）患者的术后结果和并发症。
由于解剖学方面的考虑和假体周围漏的风险增加，通常避免在 BAV 患者中使用无缝线和快速部署假体。多项研究报告了使用这些假体治疗 BAV 患者的不同程度的成功。本综述的重点是整合关于该主题的现有证据。
使用多数据库（Medline、Embase、Cochrane 对照临床试验中心注册）的全面搜索策略进行范围综述，以查找相关文章。两名独立审查员根据预先确定的纳入和排除标准筛选所有摘要和全文。最终有 13 篇文章，包括病例报告和病例系列，被纳入分析。
在 1052 条总引用中，有 44 条进行了全文审查，13 条（4 篇病例报告、6 篇回顾性分析和 3 篇前瞻性分析）被纳入范围综述。在所有 13 项研究中，共有 314 名 BAV 患者用于数据分析。在无缝线和快速部署假体中，所有研究的术后主动脉瓣梯度均小于 15mmHg，所有研究的术后主动脉瓣面积均大于 1.3cm²。总共有 186 例并发症，总并发症发生率为 59%。个别并发症包括新发心房颤动（n=65）、需要起搏器植入（n=24）、瓣周主动脉瓣反流（n=20）、新发房室传导阻滞（n=18）和新发瓣周漏（n=10）。
在 BAV 患者中使用无缝线和快速部署假体的术中及植入成功率与无 BAV 患者相似。在 BAV 患者中使用这些假体的术后并发症包括新发心房颤动、瓣周主动脉瓣反流、新发房室传导阻滞和需要起搏器植入。已经描述了各种技术来最小化 BAV 患者接受无缝线或快速部署假体时的这些并发症。
