Development Of Aortic Valve Replacement Research Articles

Historical aspects of aortic valve replacement using autologous pericardium: do we know everything?

Highlights. The article describes the contribution of foreign and Russian surgeons to the development of aortic valve replacement using autologous tissue, and presents the evolution of the technique. The authors tried to answer the question whether the Japanese professor S. Ozaki actually developed something new or the discovery was already made 40 years ago. At the end of the article, the technique developed by a Russian cardiac surgeon is presented, casting doubt on the use of templates in this procedure.Abstract. Aortic valve replacement using autologous pericardium (neocuspidalization) is becoming an increasingly attractive option that can be applied to a wide range of aortic valve diseases. This technique avoids the need for lifelong administration of anticoagulant drugs, and provides the maximum effective orifice area, resulting in a low transvalvular gradient. The new technique, introduced by Shigeyuki Ozaki, has made the procedure more reproducible with promising medium- and longterm results. But is Ozaki the predecessor of this technique or is “all new is well forgotten old”? This review focuses on the historical aspects of the development of neocuspidalization of the aortic valve using autologous pericardium, the first interventions for valve reconstruction are mentioned, the evolution in the technique of preparation and fixation of the leaflets is reflected.

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

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.