Rapid Deployment Valve in Endocarditis Patients

Objective: Using rapid deployment valves (RDV) mean cross-clamp, cardiopulmonary bypass and surgical times are shorter in comparison to conventional procedures with acceptable long-term safety and excellent hemodynamic performances at the same time. RDV lead to less early complications as prolonged ventilation, renal replacement therapy, etc. Especially in high risk patients, as endocarditis patients, this seems to be an advantage. RVD systems have already been used successfully for re-operation to treat failed stentless bioprosthetic valves. At the moment there is no consensus on which is the optimal prosthesis to implant in endocarditis patients. So we used RDVs in native and re- AV endocarditis patients calculating all this arguments, though an international expert consensus defined a contraindication for annular abscess or destruction due to infective endocarditis.

Methods: 13 patients who received RDV (Edwards Intuity Elite, Edwards, USA) during 01/2016 and 08/2017 due to AV endocarditis were included. 8 patients with native valve endocarditis (NEG), 5 patients received reoperation (ROG) due to aortic valve prostheses endocarditis. A retrospective analyzation of intraoperative and early postoperative outcome was performed.

Results: Mean age at the baseline was 67 ± 5.5 years in NEG and 67 ± 9.5 years in ROG. Log. EuroSCORE was 73.27 ± 17.9% in ROG and 55.9 ± 27.5% in NEG. Intraoperative data showed: mean bypass time in NEG 78.38 ± 8.5 minutes/ROG 133.8 ± 35.3 minute, X-clamp time NEG 50.88 ± 4.5 minutes/POG 43.8 ± 11.3 minutes and valve size NEG 23 ± 0.8 mm/ ROG 21 ± 1 mm. 30-day follow up showed that 1 patient in ROG died after 6 weeks at ICU, 2 patients died in NEG (after 3 and 5 weeks at ICU). Mean time at ICU was 13 days in ROG and 6 days in NEG. Acute kidney decease occurred in 1 patient in ROG and 3 patients in NEG group. In both groups only 1 patient showed postoperative AV dysfunction.

Conclusion: It is a feasible method to implant RDVs in high risk endocarditis patients. Intraoperative and early postoperative outcomes show acceptable results. Especially in challenging re-operations as after AVR and endocarditis, RDV seems to be a good alternative which allows us to fix the prostheses quickly and easily in the left ventricular outflow tract by the frame stent. In soft inflammation tissue this can be a great help to reconstruct the left ventricular outflow tract. However further studies are needed.