Aortic valve replacement with sutureless prosthesis: better than root enlargement to avoid patient–prosthesis mismatch?

Abstract

Although the sutureless valve patients received significantly more concomitant procedures, all operation-associated times were significantly shorter. Despite sutureless valve patients being older, the 30-day mortality and survival rates were comparable in the two groups. Since the indexed EOA was only slightly lower and the incidence of severe PPM was not significantly higher in the sutureless valve patients, we conclude that sutureless valve implantation is an alternative to conventional ARE to treat a small aortic annulus and avoid PPM, especially in geriatric patients who benefit from the quick implantation process.

Direct Comparison of the Edwards Intuity Elite and Sorin Perceval S Rapid Deployment Aortic Valves

“…We could not detect a time benefit in terms of reduced CPB or aortic clamp time favoring one RDV type over the other. Both RDV have been repeatedly linked to a significant reduction in CPB and aortic clamp time when compared with conventional bioprosthetic AVR [5,6,8,9,19,21], with CPB and aortic cross-clamp times being similar to our report. For example, the Intuity RDV facilitated a 24% reduction in aortic cross-clamp time compared with conventional AVR in the CANDENCE-MIS [8]; and the TRANSFORM investigators reported a clinically meaningful reduction of CPB and aortic clamp time, especially for patients with combined AVR and CABG procedures when compared with the corresponding results of The Society of Thoracic Surgeons Adult Cardiac Surgery Database [5].…”

“…For example, the Intuity RDV facilitated a 24% reduction in aortic cross-clamp time compared with conventional AVR in the CANDENCE-MIS [8]; and the TRANSFORM investigators reported a clinically meaningful reduction of CPB and aortic clamp time, especially for patients with combined AVR and CABG procedures when compared with the corresponding results of The Society of Thoracic Surgeons Adult Cardiac Surgery Database [5]. Similarly, a 20% to 40% reduction of CPB time and aortic clamp time was observed with the Perceval RDV for isolated or combined RDAVR procedures compared with conventional AVR [9,13,19]. Nonetheless, the potential benefit of RDV-facilitated reduction of CPB and aortic clamp time on hard clinical endpoints remains to be proven in future clinical trials for both isolated and combined procedures.…”

“…Rapid deployment valves (RDV) for AVR (RDAVR) have been introduced throughout the past years to facilitate shorter operation times and minimize surgical access while maintaining the advantages of surgical excision of degenerated aortic valve tissue [4][5][6][7]. Their design with expandable stents enables easy and rapid implant and thereby reduces cardiopulmonary bypass (CPB) and aortic clamp times while providing excellent hemodynamic performance when compared with conventional stented valve prostheses [4][5][6][8][9][10][11]. Importantly, early and midterm data show good durability and hemodynamic performance and low valve-related complications [6-8, 10, 12], and suggest that the use of RDAVR could be of clinical benefit for patients at high operative risk requiring combined procedures or minimally invasive AVR.…”

Perceval S and Coronary Artery Bypass Grafting, Contradiction or Full Harmony?

“…Several authors described their results with the use of Perceval S bioprostheses in high risk patients, with minimally invasive approach or in combined surgery [2][3][4][5][6][7][8][9][10]. However no one describes the experience of combined Perceval S aortic valve replacement with concomitant myocardial revascularization.…”

Optimising the Haemodynamics of Aortic Valve-in-valve Procedures

“…20,21 Recently, sutureless valves have also been proposed as an alternative to aortic root enlargement; they have an acceptable safety profile while allowing for a larger valve size to be inserted. 22 Another meta-analysis showed that stentless valves provide larger effective orifice areas, lower mean gradient and greater ventricular mass regression. 23 In addition, techniques such as aortic root enlargement to allow for the insertion of larger bioprosthetic valves are occasionally considered for patients at risk of severe PPM.…”