PERIOPERATIVE OUTCOMES OF NEW RAPID-DEPLOYMENT AORTIC VALVE REPLACEMENT WITH THE EDWARDS INTUITY VALVE SYSTEM

Abstract

The recent emergence of new rapid-deployment valves could reduce the mean cross-clamping time and average bypass time in complex combined procedures and could facilitate minimally invasive access. The aim of this study was to evaluate perioperative results of the EDWARDS INTUITY valve implantation in aortic position in patients who underwent aortic valve replacement (AVR) by minimally invasive access or with concomitant procedure. Between January 2011 and December 2014, 45 patients underwent aortic valve replacement with prosthesis INTUITY at Montréal Heart Institute. The surgical approach was median sternotomy in 29 cases of concomitant surgery (65%) and minimally invasive way in 16 isolated AVR (35%). AVR was conducted successfully in all cases. The mean age of patients was 70 ± 7.6 years. The preoperative EuroSCORE II was 3.23 ± 3.3% and 86% (n = 36) of patients were male. Concomitant procedures included coronary bypass surgery in 23 patients (51%), a ring expansion (2%), two ascending aorta replacements (4%), one aortic plasty with pericardial patch (2%), and a tricuspid annuloplasty (2%). Six patients (13%) had a previous cardiac surgery. In isolated AVR, average bypass time and mean clamping time were 67.4 ± 15.9 and 48.9 ± 16.8 min, respectively. In concomitant procedures, mean bypass time and cross-clamping time were 75.8 ± 28.2 and 90.8 ± 45.1 min, respectively. There was no 30-day mortality. The mean postoperative transprosthetic gradient was 12.5 ± 4.3 mmHg. Postoperative effective orifice area was 2.0 ± 0.5 cm2. One case (2%) of mild paravalvular leak occured. All patients were in NYHA functional class I or II / IV after surgery. The implantation of a permanent pacemaker was required in 6 patients (13%). Three (6%) patients had bleeding requiring reoperation, and five patients (11%) developed acute renal failure. The average length of ICU stay was 2.2 ± 1.8 days. The mean bypass time and cross-clamping time were acceptable for isolated AVR or in combined procedures. The Edwads Intuity valve demonstrates good hemodynamic results. However, future studies allowing comparison with other sutureless valve as well as long-term durability and safety are mandatory.