OC21 EARLY OUTCOMES OF MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT WITH RAPID DEPLOYMENT BIOPROSTHESES: INSIGHTS FROM AN ITALIAN NATIONAL REGISTRY.

Abstract

Background and Aim: Rapid-deployment bioprostheses (RDBs) represent one therapeutic option for patients with aortic valve stenosis (AVS). Their theoretical advantages are the reduction of procedural times and the facilitation of minimally invasive operations. Aim of this retrospective multicenter study was to assess early outcomes of isolated aortic valve replacement (iAVR) with RDB performed through mini-sternotomy (MS). Methods: We analyzed data of iAVR through MS approach from a National Registry of RDB. Preoperative variables were defined according to Euroscore II system and postoperative outcomes were reported according to VARC-2 definitions. Results: From April 2012 to March 2018, 450 consecutive patients (21 centers) underwent iAVR through MS for AVS. Mean age was 74 ± 7.5 years and 231 (51.1%) were females. Logistic Euroscore I, Euroscore II and STS-PROM score were 6.7 ± 5.3%, 2.0 ± 1.4% and 2.2 ± 1.7%, respectively. Mean cardiopulmonary bypass and aortic cross-clamping times were 88.4 ± 30.4 minutes and 59.5 ± 20.8 minutes, respectively. Peripheral cannulation was performed in 243 cases (54%). Conversion to full-sternotomy occurred in 8 patients (1.8%). VARC device success was 98% (441 cases). Early mortality was 0.7% (3 patients). VARC major postoperative complications were 19 (4.2%) and 28 patients required new permanent pace-maker (6.2%). Postoperative echocardiography revealed a mean transprosthetic gradient of 11.3 ± 4.6 mmHg, a mean indexed AVA of 1.15 ± 0.32 cm2/m2 and a total of 27 (6%) paravalvular leaks (24 mild and 3 moderate). Conclusions: Our data suggest that RDBs allow performing iAVR using a minimally invasive approach with good perioperative clinical and hemodynamic outcomes, with a low rate of postoperative complications.