Rapid deployment valve system shortens operative times for aortic valve replacement through right anterior minithoracotomy

Abstract

BackgroundThere is growing evidence from the literature that right anterior minithoracotomy aortic valve replacement (RAT-AVR) improves clinical outcome. However, increased cross clamp time is the strongest argument for surgeons not performing RAT-AVR. Rapid deployment aortic valve systems have the potential to decrease cross-clamp time and ease this procedure. We assessed clinical outcome of rapid deployment and conventional valves through RAT.MethodsSixty-eight patients (mean age 76 ± 6 years, 32% females) underwent RAT-AVR between 9/2013 and 7/2015. According to the valve type implanted the patients were divided into two groups. In 43 patients (R-group; mean age 74.1 ± 6.6 years) a rapid deployment valve system (Edwards Intuity, Edwards Lifesciences Corp; Irvine, Calif) and in 25 patients (C-group; mean age 74.2 ± 6.6 years) a conventional stented biological aortic valve was implanted.ResultsAortic cross-clamp (42.1 ± 12 min vs. 68.3 ± 20.3 min; p < 0.001) and bypass time (80.4 ± 39.3 min vs. 106.6 ± 23.2 min; p = 0.001) were shorter in the rapid deployment group (R-group). We observed no differences in clinical outcome. Postoperative gradients (R-group: max gradient, 14.3 ± 8 mmHg vs. 15.5 ± 5 mmHg (C-group), mean gradient, 9.2 ± 1.7 mmHg (R-group) vs. 9.1 ± 2.3 mmHg (C-group) revealed no differences. However, larger prostheses were implanted in C-group (25 mm; IQR 23–27 mm vs. 23 mm; IQR 21–25; p = 0.009).ConclusionsOur data suggest that the rapid deployment aortic valve system reduced cross clamp and bypass time in patients undergoing RAT-AVR with similar hemodynamics as with larger size stented prosthesis. However, larger studies and long-term follow-up are mandatory to confirm our findings.

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]…”

“…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%). Clinical follow-up was reported in 12 studies [4][5][6][7]14,[16][17][18][19]21,22,28 up to an average follow-up duration of 2.9 years (Table 1).…”

“…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%).…”

Review of minimal access versus transcatheter aortic valve replacement for patients with severe aortic stenosis

“…The main drawback is the technical difficulty and prolonged AXC and CPB times. However, the utilization of sutureless valve implants has been shown to circumvent both of these pitfalls (21,22,26,29,30). Although miniAVR is more invasive than TAVR, it retains the advantages inherent to SAVR.…”