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

Constanze Bening,Ina Schade,Rainer Leyh,Armin Gorski,Mehmet Oezkur,Khaled Hamouda,Ivan Aleksic,Christoph Schimmer

doi:10.1186/s13019-017-0598-0

Constanze Bening, Ina Schade + Show 6 more

Open Access

https://doi.org/10.1186/s13019-017-0598-0

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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.

Highlights

There is growing evidence from the literature that right anterior minithoracotomy aortic valve replacement (RAT-AVR) improves clinical outcome
There is no data showing that the Edwards Elite valve system may result in shorter cross clamp and cardiopulmonary bypass times compared with conventional biological aortic valves, through a right anterior minithoracotomy approach
Demographic data were comparable, the incidence of diabetes mellitus was higher in the rapid deployment valve group (R-group)

Summary

Introduction

There is growing evidence from the literature that right anterior minithoracotomy aortic valve replacement (RAT-AVR) improves clinical outcome. The data from recent publications clearly demonstrate the safety and effectiveness of rapid deployment valves, showing reduced aortic cross clamp and cardiopulmonary bypass time compared to standard stented biological valves [2, 17, 18]. Only few studies published data regarding rapid deployment valves for RAT-AVR and none of them reported results with the Edwards Intuity Elite rapid deployment valve sytem [4, 5]. There is no data showing that the Edwards Elite valve system may result in shorter cross clamp and cardiopulmonary bypass times compared with conventional biological aortic valves, through a right anterior minithoracotomy approach

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