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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg
DOI: 10.1055/a-2508-0732
Original Cardiovascular

Outcomes of RDAVR with Coronary Revascularization: 3-year Results from the German INCA Registry

Aristidis Lenos
1   Rhön Klinikum Campus Bad Neustadt, Bad Neustadt, Bayern, Germany
,
Justus T. Strauch
2   Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
,
Markus Schlömicher
2   Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
,
Felix Fleissner
3   Universitätsklinikum Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
,
Diana M. Valencia-Nunez
4   Klinikum Links der Weser gGmbH, Bremen, Bremen, German
,
Jens Garbade
4   Klinikum Links der Weser gGmbH, Bremen, Bremen, German
,
Roman Gottardi
5   Department of Cardiac and Vascular Surgery, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Baden-Württemberg, Germany
,
Parwis Massoudy 
6   Department of Cardiac Surgery, Klinikum Passau, Passau, Germany
,
Markus Kamler
7   Universitätsmedizin Essen, Essen, Nordrhein-Westfalen, Germany
,
Rizwan Malik
7   Universitätsmedizin Essen, Essen, Nordrhein-Westfalen, Germany
,
Gerhard Wimmer-Greinecker
8   Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany
,
Thomas Walther
9   Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
,
Jan Gummert
10   Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
,
Peter Bramlage 
11   Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
,
Anno Diegeler
1   Rhön Klinikum Campus Bad Neustadt, Bad Neustadt, Bayern, Germany
› Institutsangaben Funding This work was supported with a research grant provided by Edwards Lifesciences (Nyon, Switzerland, grant number: HVT-R17-011) to the sponsor IPPMed (Cloppenburg, Germany).
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Abstract

Background The long-term outcomes of combined rapid-deployment aortic valve replacement (RDAVR) with coronary artery bypass graft surgery (CABG) are not well explored. We report 3-year results from the INCA registry on combined RDAVR with CABG.

Methods INCA is a prospective, multicenter registry that enrolled 224 patients undergoing RDAVR with CABG at 10 cardiac institutions in Germany. Prosthetic valve hemodynamics, clinical outcomes, and quality of life (QoL) up to 3 years were assessed.

Results The mean age of patients was 73.6 ± 6.1 years, and the mean logistic EuroSCORE was 7.8 ± 6.0%. The mean number of distal arterial and venous anastomoses was 3.13 ± 1.56, aortic cross-clamp time was 79.4 ± 24.1 minutes, cardiopulmonary bypass time was 109.6 ± 34.5 minutes, and operation time was 224.2 ± 62.7 minutes. The majority of implanted valve size was 25 mm. At baseline, 11 patients (4.9.%) had a permanent pacemaker. Postoperatively, 17 patients (7.6%) required a new pacemaker implantation (5.4% valve-related). All-cause mortality at 30 days was 2.2%, and 11.2% at 3 years. Patient QoL (SF-12v2) was significantly restored and maintained for up to 3 years (p < 0.001). Five patients (0.9%) underwent reoperation related to endocarditis. The postimplant mean gradient was 9.2 ± 3.7 at discharge and 8.9 ± 4.6 mm Hg at 3 years.

Conclusion Combined RDAVR with CABG procedure is safe and effective over time. It offers stable and low transvalvular gradients with satisfactory clinical outcomes at 3 years. The pacemaker rate appears to be slightly increased, with no significant clinical effect at 3 years.

Keywords

rapid-deployment aortic valve replacement - structural valve degeneration - valve durability

Ethical Approval Statement

The study documents were submitted to the ethics committees responsible for each site and there were no objections to conducting the study. Formal written informed consent was obtained from every patient before enrolment.


Authors' Contribution

A.D., J.S., M.S., F.F., and A.L. were involved in the conception and design of the study. The idea was discussed and refined by the rest of the authors. D.M.V., J.G., R.G., P.M., M.K., R.M., G.W., T.W., and J.G. contributed significantly to study execution, acquisition of data, analysis, and interpretation. P.B. drafted the manuscript and all the other authors revised the article for important intellectual content. All the authors gave approval for the final version.


Data Availability Statement

All relevant data within this manuscript will be shared upon reasonable request to the corresponding author.


Supplementary Material



Publikationsverlauf

Eingereicht: 30. Juli 2024

Angenommen: 16. Dezember 2024

Artikel online veröffentlicht:
27. Januar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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