Initial Experience with Aortic Valve Replacement via a Minimally Invasive Approach: A Comparison of Stented, Stentless and Sutureless Valves

Abstract

BackgroundThis study aimed to compare the short-term outcomes of MIS-AVR among 3 different types of biological heart valves.Material/MethodsComplete data were obtained from 79 patients who underwent MIS-AVR between January 2010 and June 2015. Patients were divided into 3 groups: 27 patients (group A) received Medtronic 3f® (Medtronic Inc., Fridley, MN, USA), 36 patients (group B) received DokimosPlus® (LabCor Laboratórios Ltda., Belo Horizonte, Brazil) and 16 patients (group C) received Perceval® (Sorin Biomedica Cardio S.r.l., Saluggia VC, Italy) valves.Operative and postoperative parameters such as duration of operation, bypass time, duration of ventilation, morbidity, and mortality were statistically analyzed using the Kruskal-Wallis test. Hemodynamic assessment with transthoracic echocardiography was performed before discharge.ResultsThe EuroSCORE II ranged between 0.67 and 6.94 with no significant difference between the groups. The median operative time was 166 min (range 90–230 min) in total, with significantly shorter times in group C (120 min [range 90–200]). The median total ventilation time was significantly lower in group C and significantly higher in group A. Hemodynamic evaluation demonstrated a mean maximal velocity (vmax) over the aortic valve of 2.3 m/s (range 0.9–4.3 m/s) with average mean and peak pressure gradient values of 10 mmHg (range 3–24 mmHg) and 20 mmHg (range 5–42 mmHg), respectively. Group A showed the highest values for vmax (H>5.99).No significant difference was found regarding duration of hospitalization. Mortality was 3%.ConclusionsIn conclusion, all 3 valves showed good perioperative results, satisfying hemodynamic performance, and low complication rates.

Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: A meta-analysis

“…Therefore, a total of 21 studies were included in this review ( Figure E1). [4][5][6][7][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]…”

“…Among the 21 studies with 2785 patients (RDAVR group ¼ 1297 patients and CAVR group ¼ 1488 patients), 2 studies presented the results of RCTs (n ¼ 144), and 19 presented the outcomes of NRSs (n ¼ 2641). Twelve studies exclusively used the Perceval S (Sorin Group; Milan; Italy), 4,5,13,[15][16][17][21][22][23]25,27,28 whereas the Edwards Intuity valve (Edwards Lifescience Corp; Irvine, Calif) was used exclusively in 5 studies. 6,7,19,20,26 A minimally invasive approach through mini-sternotomies or right anterior thoracotomies were more frequently performed in the RDAVR group than in the CAVR group (69.1% vs 37.7%).…”

“…The ROB of both studies was considered low for the other domains. Of the 19 NRSs, 11 studies 4,6,7,13,15,18,[24][25][26][27][28] were graded as overall severe ROB because of the presence of confounding biases, because the patients' baseline characteristics were not balanced across groups and appropriate adjustments for confounding factors were not used. The other 8 studies used propensity score matching 14,16,17,20,21,23,29 or 1:1 matching 5 and were rated overall moderate ROB, because the baseline characteristics were similar between groups, and the other ROB items were graded low (Table E1).…”

“…The risk of the need for PPM insertion after AVR was drawn from 17 studies with 2435 patients [5][6][7][13][14][15][16][17][18][19][21][22][23][26][27][28][29] after the exclusion of 1 study that reported no patients with a PPM insertion. 20 The pooled analysis showed that the risk of PPM insertion was significantly higher in the RDAVR group than in the CAVR group (RR, 2.08; 95% CI, 1.49-2.90; I 2 ¼ 0%).…”

“…The risks of acute renal failure, atrial fibrillation, bleeding reoperation, prolonged ventilation, and stroke were reported in 11, 7,13,17-21,23,25,28,29 9, 5,7,14,16,20,23,26,29 16, 4,6,7,14-21,23,25-27,29 6, 14,17,19,23,28,30 and 16 5,7,[13][14][15][16][17][18][19][20][21]23,[25][26][27][28] studies, respectively. The pooled analyses showed no significant differences in the risks of postoperative complications between the 2 groups ( Figure E2).…”