Comparison of sutured valves and suturless and rapid deployment valves in aortic valve surgery by minimally invasive approach

Abstract

During the development of aortic valve replacement (AVR) by minimally invasive approach, the use of suturless (Perceval) and rapid deployment valves (Intuity and Intuity Elite) grew in popularity due to they are surgical time-saving. Our aim was to evaluated the efficacy and safety of these type of valve compared to conventional sutured valve in isolated AVR by right anterior minithoracotomy (RAMT). Between September 2009 and March 2020, 546 patients underwent isolated AVR by RAMT. Patient data were collected prospectively. Statistical analysis was performed to compare the use of suturless and rapid deployment valve (SRDV) and conventional sutured valve (CV). Of the 546 patients, 398 underwent AVR using CV (72,9%) and 148 using a SDRV (27,1%). The aortic cross-clamping and cardiopulmonary bypass times were significantly decreased in SRDV group (66,6 ± 27 vs 88,5 ± 27,6 min; P < 0,001 and 95 ± 39,7 vs. 119 ± 41 min; P < 0,001). The rate of permanent pacemaker implantation was significantly higher in SRDV group (10,9 vs 1,05%; P < 0,001). Pacemaker implantation was predominant with using Perceval valve compared to Intuity valve (12,6 vs. 3,6%). The lengths of ICU and hospital stay were significantly decreased in group CV (2,5 ± 2,4 vs. 3,1 ± 3,7 days; P = 0,03 and 8,1 ± 5 vs. 8.9 ± 4.6 days; p = 0,001). The mortality rate was significantly higher (4,7 vs. 1,2%; P = 0,01) in group SRDV but the mean age and Euroscore II were significantly higher in SRDV group (76,1 + - 6,2 vs. 68,5 ± 9,8 years; P < 0.001 and 2,1 ± 1,9 vs. 1,6 ± 2,1; P < 0.001). The use of SDRV in minimally invasive aortic valve surgery reduces the duration of myocardial ischemia, but at the cost of a significant increase in rate of permanent pacemaker implantation. Their use is also associated with a significant increase in the length of stay in intensive care unit and hospital.