Clinical outcomes of two generations of pericardial bioprostheses in concomitant aortic valve and coronary artery bypass graft surgery were analyzed. Patients were recruited from two European centers and divided into 2 groups based on the type of aortic bioprosthesis used: Edwards Intuity Elite^TM rapid deployment bioprostheses or standard Edwards Magna Ease (Edwards Lifesciences, Corporation, Irvine, California, US). A propensity score weighting approach was used for data analysis. 285 patients were included: 144 (50.5%) in the Rapid Deployment group and 141 (49.5%) in the Magna Ease group. Thirty-day mortality was 2.8% (Rapid Deployment) and 5% (Magna Ease) (P = 0.089). Significantly shorter times of aortic cross-clamp and cardiopulmonary bypass were observed in the Rapid Deployment cohort [94 vs 120 min; (P < 0.001); 128 vs 160 min (P < 0.001)]. The Rapid Deployment group was associated with a lower median transvalvular gradient at discharge and follow-up (both P < 0.001). However, 5-year survival was not different, being 93% in Rapid Deployment patients and 91% in the Magna Ease group [HR 0.89 (CI 95%:0.38–2.09), P = 0.784]. The 5-year cumulative incidence of combined events (including percutaneous coronary interventions, endocarditis, thromboembolic events, rehospitalizations, and bleeding) favored the Magna Ease group [16.1% (Rapid Deployment) vs 7.3% (Magna Ease), [HR 2.38 (CI 95%:1.03–5.52), P = 0.043]. However, this turned similar when the Cox model analysis was adjusted for revascularization variables (P = 0.067). Rapid deployment and Magna Ease pericardial bioprostheses used in concomitant aortic valve replacement and coronary artery revascularization provide equivalent clinical and haemodynamic 5-year outcomes, despite constant lower transvalvular gradients and shorter surgical operating times observed with rapid deployment technology.

Background: Transcatheter aortic valve implantation (TAVI) is becoming the most important treatment strategy for aortic valve disease. With its dramatic increase, the rate of major complications and the impact of TAVI on long term outcomes is becoming a pressing issue, especially in terms of comparison with surgical aortic valve replacement (SAVR). PVE is a severe complication that can arise post-procedure, leading to significant morbidity and mortality. The aim of this meta-analysis is to compare the incidence of PVE and 30-day mortality rates between TAVI and SAVR. Methods: A comprehensive literature review was conducted, identifying studies that reported the incidence and outcomes of PVE in patients undergoing TAVI and SAVR. The selected studies were assessed for heterogeneity using the χ² test and I² statistic. A random effect model was applied to account for variability among studies. The Odds Ratios (ORs) for 30-day mortality and the incidence of PVE were calculated. Funnel plots were utilized to assess the reliability of the data and potential publication bias. Results: The analysis showed no significant difference in 30-day mortality of PVE in TAVI and SAVR, with an OR of 1.29 (CI 0.98–1.69). However, there was a significant difference in the incidence of PVE (HR 0.76, CI 0.61–0.96), with TAVI demonstrating a protective effect attributed to its lesser invasiveness and shorter procedural times. The funnel plots indicated high reliability of the data, with low standard errors and minimal publication bias. Conclusions: TAVI and SAVR carry similar 30-day mortality rates for patients with PVE; on the other hand, TAVI shows a lower incidence of PVE due to its minimally invasive nature. These findings suggest that TAVI might be a preferable option for certain patient populations, though further randomized clinical trials are needed to confirm these results and address the limitations of the current study.