Minimally invasive aortic valve replacement with sutureless and rapid deployment valves: a report from an international registry (Sutureless and Rapid Deployment International Registry)†

Abstract

OBJECTIVES: The impact of sutureless and rapid deployment (SURD) valves on the clinical outcomes of patients undergoing minimally invasive aortic valve replacement (MI-AVR) has still to be defined. The aim of this study was to assess clinical characteristics and in-hospital results of patients receiving SURD-AVR through less invasive approaches in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS: Of the 1935 patients who received primary isolated SURD-AVR between 2009 and 2018, a total of 1418 (73.3%) underwent MI interventions and were included in this analysis. SURD-AVR was performed using upper ministernotomy in 56.4% (n = 800) of cases and anterior right thoracotomy in 43.6% (n = 618). Perceval S was implanted in 1011 (71.3%) patients and Edwards Intuity or Intuity Elite in 407 (28.7%) patients. RESULTS: Overall in-hospital mortality and stroke rates were 1.7% and 2%, respectively. A definitive pacemaker implantation was reported in 9% of cases and significantly decreased over the observational period, from 20.6% to 5.6% (P = 0.002). The Perceval valve was associated with shorter operative times and was more frequently implanted in patients receiving anterior right thoracotomy incision. The Intuity valve was preferred in younger patients and revealed superior postoperative haemodynamic results. CONCLUSIONS: SURD-AVR was largely performed through less invasive approaches and can be considered as a primary indication in MI surgery. In the SURD-IR cohort, MI SURD-AVR using both Perceval and Intuity valves appeared a safe and reproducible procedure associated with promising early results.

Minimally invasive access type related to outcomes of sutureless and rapid deployment valves

“…This may also present a potential issue for younger patients, who would require a permanent pacemaker. However, we reported a relevant risk reduction of 5.6% in the most recent cohort due to growing surgical experience, which was also shown in the current report for minimally invasive approaches [ 3 ]. Furthermore, a recent analysis of conduction disturbances after rapid deployment aortic valves revealed preoperative right bundle branch block as a strong risk factor for pacemaker implantation [ 28 ].…”

“…We were able to show improved laminar flow for the Edwards Intuity valve, which opens the left ventricular outflow tract with the stent part of the valve [ 24 ]. This reduces transvalvular gradients and may be a relevant factor contributing to the excellent long-term survival in this patient population [ 3 , 23 , 25 , 26 ]. This is also a very important argument in the current discussion regarding the low-risk patient population, as the recent Partner 3 trial revealed higher gradients in the TAVI cohort than that in the surgical comparator [ 19 ].…”

Establishment of an enhanced recovery after surgery protocol in minimally invasive heart valve surgery

“…Due to infrastructural and logistic circumstances in the implementation phase of our program, these patients were transferred to ICU overnight. Although our study was not designed to show the superiority of ERAS protocol as compared to the standard perioperative management, perioperative morbidity was very comparable to the recent findings in patients with sutureless aortic valve replacement [25].…”

Aortic valve replacement using stented or sutureless/rapid deployment prosthesis via either full-sternotomy or a minimally invasive approach: a network meta-analysis

“…In the recent years, the treatment of aortic valve disease has been increasingly focused towards developing and popularizing less invasive procedures. By facilitating and shortening the valve implantation process, the sutureless and rapid deployment (SURD) valves have significantly contributed to simplify and promote minimally invasive approaches (53,54). As confirmed in the present metaanalysis, minimally invasive aortic valve replacement (MI-AVR) and SURD valves have described to be associated with equivalent very low mortality and stroke risk compared to conventional AVR.…”