The use of pledget-reinforced sutures during surgical aortic valve replacement: A systematic review and meta-analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2024-08-22 DOI:10.1016/j.ijcha.2024.101494

J.W. Taco Boltje , Mathijs T. Carvalho Mota , Michiel D. Vriesendorp , Alexander B.A. Vonk , Rolf H.H. Groenwold , Robert J.M. Klautz , Bart J.J. Velders

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引用次数: 0

Abstract

Objective

Literature presents conflicting results on the pros and cons of pledget-reinforced sutures during surgical aortic valve replacement (SAVR). We aimed to investigate the effect of pledget-reinforced sutures versus sutures without pledgets during SAVR on different outcomes in a systematic review and meta-analysis.

Methods

A literature search was performed in five different medical literature databases. Studies must include patients undergoing SAVR and must compare any pledget-reinforced with any suturing technique without pledgets. The primary outcome was paravalvular leakage (PVL), and secondary outcomes comprised thromboembolism, endocarditis, mortality, mean pressure gradient (MPG) and effective orifice area (EOA). Results were pooled using a random-effects model as risk ratios (RRs) or mean differences (MDs) for which the no pledgets group served as reference.

Results

Nine observational studies met the inclusion criteria. The risk of bias was critical in seven studies, and high and moderate in two other. The pooled RR for moderate or greater PVL was 0.59 (95 % confidence interval [CI] 0.13, 2.73). The pooled RR for mortality at 30-days was 1.02 (95 % CI 0.48, 2.18) and during follow-up was 1.15 (95 % CI 0.67, 2.00). For MPG and EOA at 1-year follow-up, the pooled MDs were 0.60 mmHg (95 % CI −4.92, 6.11) and −0.03 cm² (95 % CI −0.18, 0.12), respectively.

Conclusions

Literature on the use of pledget-reinforced sutures during SAVR is at high risk of bias. Pooled results are inconclusive regarding superiority of either pledget-reinforced sutures or sutures without pledgets. Hence, there is no evidence to support or oppose the use of pledget-reinforced sutures.

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查看原文本刊更多论文

在主动脉瓣置换手术中使用质粒加固缝合线：系统回顾和荟萃分析

目的文献中关于手术主动脉瓣置换术（SAVR）中衬垫加固缝合的利弊结果相互矛盾。我们的目的是通过系统性回顾和荟萃分析，研究在 SAVR 过程中，有衬垫加固缝合与无衬垫缝合对不同结果的影响。方法在五个不同的医学文献数据库中进行文献检索。研究必须包括接受 SAVR 的患者，并且必须比较任何有衬垫加固的缝合技术和任何无衬垫的缝合技术。主要结果为腔静脉旁漏（PVL），次要结果包括血栓栓塞、心内膜炎、死亡率、平均压力梯度（MPG）和有效孔面积（EOA）。结果九项观察性研究符合纳入标准。其中 7 项研究的偏倚风险为严重，另外 2 项研究的偏倚风险为高度和中度。中度或以上 PVL 的汇总 RR 为 0.59（95 % 置信区间 [CI] 0.13，2.73）。30天死亡率的汇总RR为1.02（95 % CI 0.48，2.18），随访期间的汇总RR为1.15（95 % CI 0.67，2.00）。对于随访 1 年的 MPG 和 EOA，汇总的 MD 分别为 0.60 mmHg (95 % CI -4.92, 6.11) 和 -0.03 cm2 (95 % CI -0.18, 0.12)。汇总的结果并不能确定有衬垫加固缝合线或无衬垫缝合线的优越性。因此，没有证据支持或反对使用栓塞加固缝合线。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.