Department of Cardiothoracic Surgery, All India Institute of Medical Sciences (AIIMS), Deoghar, Jharkhand, India.
Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Deoghar, Jharkhand, India.
Asian Cardiovasc Thorac Ann. 2023 Jul;31(6):524-532. doi: 10.1177/02184923231187055. Epub 2023 Jul 7.
Very few studies provide direct comparisons between aortic root enlargement and sutureless valve implantation in patients with a small aortic annulus who underwent aortic valve replacement. This study aims to provide comparative outcomes between the two in such a subset of patients, through a systematic review and pool analysis.
The PubMed, Scopus and Embase databases were searched using the appropriate terms. The data from original articles mentioning aortic root enlargement and sutureless valves in a single or comparative study with another group of patients with a small aortic annulus were pooled and analyzed using descriptive statistics.
Both cardiopulmonary bypass (68.4 vs. 125.03 min, < 0.001) and aortic cross-clamp times were significantly shorter in the sutureless valve group, along with a concomitantly higher number of minimally invasive surgeries. The incidence of permanent pacemaker implantation (9.76% vs. 3.16%, < 0.00001), patient prosthesis mis-match and paravalvular leak was significantly higher in the sutureless valve group. In comparison, the incidence of re-exploration for bleeding was higher in the aortic root enlargement group (5.27% vs. 3.16%, < 0.02). The two groups had no differences in the duration of hospital stays or mortality.
Sutureless valves demonstrated a comparable hemodynamic outcome with aortic root enlargement in patients with a small aortic annulus. In addition to this, it greatly facilitated minimally invasive surgery. However, the high incidence of pacemaker implantation is still a concern for the widespread recommendation of sutureless valves, especially in young patients with a small aortic annulus.
在接受主动脉瓣置换术的小主动脉瓣环患者中，很少有研究对主动脉根部扩大和无缝线瓣膜植入进行直接比较。本研究旨在通过系统评价和汇总分析，为这类患者提供两种方法的比较结果。
使用适当的术语在 PubMed、Scopus 和 Embase 数据库中进行搜索。将提到主动脉根部扩大和无缝线瓣膜的原始文章中的数据汇总并进行分析，这些文章是在单一或与另一组小主动脉瓣环患者进行比较的研究中提到的，使用描述性统计方法。
无缝线瓣膜组的体外循环（CPB）（68.4 与 125.03 分钟， < 0.001）和主动脉阻断时间明显缩短，微创手术数量也相应增加。无缝线瓣膜组永久性起搏器植入（9.76%与 3.16%， < 0.00001）、患者假体不匹配和瓣周漏的发生率明显更高。相比之下，主动脉根部扩大组再次开胸止血的发生率更高（5.27%与 3.16%， < 0.02）。两组患者的住院时间或死亡率无差异。
无缝线瓣膜在小主动脉瓣环患者中与主动脉根部扩大具有可比的血液动力学结果。除此之外，它还极大地促进了微创外科手术。然而，起搏器植入的高发生率仍然是广泛推荐无缝线瓣膜的一个关注点，尤其是在小主动脉瓣环的年轻患者中。
