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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 4/2023

04-01-2023 | Aortic Valve Replacement | Review Article

Externally mounted versus internally mounted leaflet aortic bovine pericardial bioprosthesis: meta-analysis

Authors: Yujiro Yokoyama, Yosuke Sakurai, Toshiki Kuno, Hisato Takagi, Shinichi Fukuhara

Published in: General Thoracic and Cardiovascular Surgery | Issue 4/2023

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Abstract

Background

Recent studies reported higher-than-expected rates of early structural valve degeneration (SVD) and/or reoperation of externally mounted leaflet aortic bioprosthesis compared with others. This meta-analysis aims to compare the outcomes of bioprostheses with externally versus internally mounted leaflet design in patients who underwent surgical aortic valve replacement (SAVR).

Methods

MEDLINE and EMBASE were searched through November 2021 to identify comparative studies investigating outcomes following SAVR with either externally or internally mounted leaflet aortic bioprosthesis. Outcomes of interest were reoperation for SVD or any cause and all-cause mortality.

Results

Our analysis included 15 observational studies that enrolled a total of 23,539 patients who underwent SAVR using externally mounted (n = 9338; 39.7%) or internally mounted leaflet (n = 14,201; 60.3%) bioprostheses. Externally mounted valves consisted of the Trifecta (Abbott, St Paul, MN) (n = 6146) and the Mitroflow (LivaNova, London, UK) (n = 3192), and all internally mounted valves were the Perimount (Edwards Lifesciences, Irvine, CA). Externally mounted valves compared with the Perimount were associated with higher reoperation rates for SVD [hazard ratio (HR) 3.55, 95% confidence interval (CI) 2.67–4.72; P < 0.001] and any cause (HR 9.36, 95% CI 3.70–23.67; P < 0.001). Furthermore, externally mounted valves demonstrated higher all-cause mortalities (HR 1.33, 95% CI 1.13–1.56; P < 0.001).

Conclusions

The present study summarizing updated evidence revealed higher reoperation rates and all-cause mortalities in patients with externally mounted leaflet aortic bioprostheses compared with those with internally mounted design. Choosing the right SAVR valve type is critical part of lifetime management of aortic valve disease.
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Metadata
Title
Externally mounted versus internally mounted leaflet aortic bovine pericardial bioprosthesis: meta-analysis
Authors
Yujiro Yokoyama
Yosuke Sakurai
Toshiki Kuno
Hisato Takagi
Shinichi Fukuhara
Publication date
04-01-2023
Publisher
Springer Nature Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 4/2023
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-022-01904-5

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