Ali-Hasan-Al-Saegh Sadeq, Takemoto Sho, Shafiei Saeed, Yavuz Senol, Arjomandi Rad Arian, Amanov Lukman, Merzah Ali Saad, Salman Jawad, Ius Fabio, Kaufeld Tim, Schmack Bastian, Popov Aron-Frederik, Sabashnikov Anton, Ruhparwar Arjang, Zubarevich Alina, Weymann Alexander
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
J Clin Med. 2024 Aug 19;13(16):4887. doi: 10.3390/jcm13164887.
: The management of patients with aortic valve pathologies can sometimes fall into a "gray zone", where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the "gray zone" of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan-Meier-based meta-analyses to compare the outcomes of SUAVR with the Perceval bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the Perceval bioprosthesis over mid-term and long-term follow-up periods. : The PubMed, PubMed Central, OVID Medline, Cochrane Library, Embase, and Web of Science databases were systematically searched. All study types were included, except study protocols and animal studies, without time restrictions. The final search was carried out in May 2024. : No statistically significant differences were observed in permanent pacemaker implantation (PPI) rates between the two groups. SUAVR showed a lower incidence of new-onset myocardial infarction but was associated with higher rates of new-onset atrial fibrillation and major bleeding. TAVI had higher rates of left bundle branch block and major vascular complications. : Our findings show that SUAVR has a lower incidence of complications and a favorable mid-term overall survival compared to TAVI. SUAVR has more advantages compared to TAVI and can be considered a valuable and promising option for the "grey zone" of aortic valve pathologies.
主动脉瓣病变患者的管理有时会陷入一个“灰色地带”，即最佳治疗方法并不明确。使用Perceval生物假体的无缝合主动脉瓣置换术（SUAVR）与经导管主动脉瓣植入术（TAVI）在主动脉瓣置换手术“灰色地带”的相对益处仍是一个有争议的话题。为了进一步探讨这个问题，我们进行了一项研究，采用成对、单臂和基于Kaplan-Meier的荟萃分析，比较使用Perceval生物假体的SUAVR与TAVI的结果，并评估使用Perceval生物假体的SUAVR在中期和长期随访期的疗效、安全性和耐久性。
系统检索了PubMed、PubMed Central、OVID Medline、Cochrane图书馆、Embase和Web of Science数据库。纳入所有研究类型，但不包括研究方案和动物研究，无时间限制。最终检索于2024年5月进行。
两组之间在永久起搏器植入（PPI）率方面未观察到统计学显著差异。SUAVR新发心肌梗死的发生率较低，但与新发房颤和大出血的发生率较高相关。TAVI左束支传导阻滞和主要血管并发症的发生率较高。
我们的研究结果表明，与TAVI相比，SUAVR并发症发生率较低，中期总体生存率良好。与TAVI相比，SUAVR具有更多优势，可被视为主动脉瓣病变“灰色地带”的一个有价值且有前景的选择。
