Intermediate Outcomes after Rapid Deployment Aortic Valve Replacement in Multiple Valve Surgery

Abstract

Background Multiple valve surgery is associated with significant higher operative risks. Reduced cross-clamp and cardiopulmonary bypass times in multiple valve surgery may potentially be beneficial as they can be considered independent risk factors for increased morbidity and mortality following cardiac surgery. We report first intermediate outcomes of the Edwards Intuity valve system (Edwards Lifesciences, Irvine, California, United States) in combined procedures Methods Fifty-eight patients underwent rapid deployment aortic valve replacement with concomitant mitral valve surgery between January 2014 and November 2017 in our institution. The valve was assessed echocardiographically after 12 months. The median follow-up was 1.7 years with a cumulative follow-up time of 115.3 patient years. Results The mean age was 73.5 ± 6.2 years and the mean logistic Euroscore was 11.6 ± 3.1%. Concomitant mitral valve repair was performed in 43 cases (74.1%), and mitral valve replacement in 15 cases (19.0%). The mean cross-clamp time was 93 ± 21 minutes along with a mean bypass time of 118 ± 24 minutes. All-cause mortality after 30 days was 8.6%. Overall actuarial survival at 1 year was 87.2 ± 4.5% and after 2 years 82.8 ± 5.3%, respectively. Conclusions Rapid deployment aortic valve replacement in multiple valve surgery can be performed safely with good intermediate outcomes in elderly, high-risk patients.

Single-Center Outcomes with Rapid Deployment Aortic Valve Replacement

“…Two aspects are important: the orientation of the commissural struts and the height of the aortomitral continuity, which defines the subannular space. 16,17,19,20 We showed a mean cross-clamp time of 93 AE 21 minutes in a recently published series for rapid deployment valves in a multiple valve setting. Survival at 1 year was 87.2 AE 4.5%.…”

“…Survival at 1 year was 87.2 AE 4.5%. 19 All isolated aortic valve procedures were performed using a minimal access technique, usually a hemisternotomy. A mean cross-clamp time of 37 AE 19 minutes was seen.…”

“…However, only a few experiences with rapid deployment AVR in multiple valve surgery exists. [16][17][18][19] Some procedural aspects in this setting have to be considered. Rapid deployment valves may interfere with prostheses in the mitral position.…”

“…3,25 Linearized bleeding rate of 0.8% per patient-year, stroke rates of 0.7% per patient-year, and endocarditis rate of 0.4% per patient-year match literature data. [6][7][8]11,15,17,[19][20][21][22][23][24] Increased endocarditis rates due to the subvalvular cuff material were not seen within this intermediate period.…”

Systematic review and meta-analysis of long-term outcomes in adults undergoing the Ross procedure

“…The landscape of aortic valve intervention has been consistently evolving over the last few decades for all treatment options, be it mechanical valves that require lower reference international normalized ratios (INRs) with improved transvalvular gradients (33), rapid deployment bioprosthetic valves to reduce implantation times and simplify operative intervention (34)(35)(36) and the revolutionary advent of transcatheter valve intervention. Nevertheless, the decision making on the optimal prosthesis for young patients is still far from easy.…”