Single-Center Outcomes with Rapid Deployment Aortic Valve Replacement

Abstract

Objectives Rapid-deployment valves can reduce procedural times and may facilitate minimally invasive surgery. In our institution, more than 500 patients underwent rapid deployment aortic valve replacement (AVR).

Methods A total of 510 patients underwent rapid deployment AVR between March 2012 and September 2017, of whom 270 patients underwent isolated AVR and 240 underwent AVR with concomitant procedures. The cumulative follow-up time was 1,444 patient-years, the median follow-up time 2.8 years, respectively

Results An early all-cause mortality of 3.5% (n = 18) was seen with a cumulative survival of 91.9 ± 2.2% after 12 months. Mean cross-clamp times were 37 ± 19 minutes for isolated AVR and 93 ± 29 minutes for AVR with concomitant procedures. The rate of new pacemaker implantation was 7.8% (n = 40). No case of structural degeneration occurred in the follow-up. Three (0.6%) cases of endocarditis were registered.

Conclusions Rapid deployment AVR can be performed safely with low complication rates and good hemodynamic results. Therefore, the relevance in aortic valve surgery can be stressed.

Keywords

aortic valve - valve surgery - echocardiography

Disclaimer

The authors confirm that they had full freedom of investigation and full control of the design of the study, methods used, outcome parameters and results, analysis of data, and production of the written report.

Publikationsverlauf

Eingereicht: 05. Februar 2020

Angenommen: 08. Mai 2020

Artikel online veröffentlicht:
16. Juli 2020

• References

• 1 Beckmann A, Funkat AK, Lewandowski J. et al. German Heart Surgery Report 2015: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2016; 64 (06) 462-474
• 2 Kodali SK, Williams MR, Smith CR. et al; PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366 (18) 1686-1695
• 3 Leon MB, Smith CR, Mack MJ. et al; PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016; 374 (17) 1609-1620
• 4 Reardon MJ, Van Mieghem NM, Popma JJ. Surgical or transcatheter aortic-valve replacement. N Engl J Med 2017; 377 (02) 197-198
• 5 Hatoum H, Moore BL, Maureira P, Dollery J, Crestanello JA, Dasi LP. Aortic sinus flow stasis likely in valve-in-valve transcatheter aortic valve implantation. J Thorac Cardiovasc Surg 2017; 154 (01) 32-43.e1
• 6 Kocher AA, Laufer G, Haverich A. et al. One-year outcomes of the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the EDWARDS INTUITY Valve System. J Thorac Cardiovasc Surg 2013; 145 (01) 110-115
• 7 Borger MA, Moustafine V, Conradi L. et al. A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement. Ann Thorac Surg 2015; 99 (01) 17-25
• 8 Schlömicher M, Haldenwang PL, Moustafine V, Bechtel M, Strauch JT. Minimal access rapid deployment aortic valve replacement: initial single-center experience and 12-month outcomes. J Thorac Cardiovasc Surg 2015; 149 (02) 434-440
• 9 Nishimura RA, Otto CM, Bonow RO. et al; American College of Cardiology; American College of Cardiology/American Heart Association; American Heart Association. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2014; 148 (01) e1-e132
• 10 Zoghbi WA, Chambers JB, Dumesnil JG. et al; American Society of Echocardiography's Guidelines and Standards Committee; Task Force on Prosthetic Valves; American College of Cardiology Cardiovascular Imaging Committee; Cardiac Imaging Committee of the American Heart Association; European Association of Echocardiography; European Society of Cardiology; Japanese Society of Echocardiography; Canadian Society of Echocardiography; American College of Cardiology Foundation; American Heart Association; European Association of Echocardiography; European Society of Cardiology; Japanese Society of Echocardiography; Canadian Society of Echocardiography. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr 2009; 22 (09) 975-1014 , quiz 1082–1084
• 11 Johnston DR, Soltesz EG, Vakil N. et al. Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants. Ann Thorac Surg 2015; 99 (04) 1239-1247
• 12 Al-Sarraf N, Thalib L, Hughes A. et al. Cross-clamp time is an independent predictor of mortality and morbidity in low- and high-risk cardiac patients. Int J Surg 2011; 9 (01) 104-109
• 13 Salis S, Mazzanti VV, Merli G. et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22 (06) 814-822
• 14 Nissinen J, Biancari F, Wistbacka JO. et al. Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery. Perfusion 2009; 24 (05) 297-305
• 15 Borger MA, Dohmen PM, Knosalla C. et al. Haemodynamic benefits of rapid deployment aortic valve replacement via a minimally invasive approach: 1-year results of a prospective multicentre randomized controlled trial. Eur J Cardiothorac Surg 2016; 50 (04) 713-720
• 16 Bechtel M, Schlömicher M, Moustafine V, Strauch JT. Rapid deployment aortic valve replacement in the setting of concomitant mitral valve procedures. Eur J Cardiothorac Surg 2017; 51 (04) 792-793
• 17 Schlömicher M, Bechtel M, Taghiyev Z. et al. The use of rapid deployment valves in combined aortic and mitral valve surgery: one-year clinical and echocardiographic outcomes. Innovations (Phila) 2017; 12 (03) 201-206
• 18 Minh TH, Mazine A, Bouhout I. et al. Expanding the indication for sutureless aortic valve replacement to patients with mitral disease. J Thorac Cardiovasc Surg 2014; 148 (04) 1354-1359
• 19 Schlömicher M, Bechtel M, Taghiyev Z. et al. Intermediate outcomes after rapid deployment aortic valve replacement in multiple valve surgery. Thorac Cardiovasc Surg 2019 (e-pub ahead of print). Doi: 10.1055/s-0039-1685178
• 20 Schlömicher M, Taghiyev Z, AlJabery Y. et al. Rapid deployment aortic valve replacement in a minimal access setting: intermediate clinical and echocardiographic outcomes. Eur J Cardiothorac Surg 2018; 54 (02) 354-360
• 21 Barnhart GR, Accola KD, Grossi EA. et al; TRANSFORM Trial Investigators. TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) US clinical trial: performance of a rapid deployment aortic valve. J Thorac Cardiovasc Surg 2017; 153 (02) 241-251.e2
• 22 Dalmau MJ, González-Santos JM, Blázquez JA. et al. Hemodynamic performance of the Medtronic Mosaic and Perimount Magna aortic bioprostheses: five-year results of a prospectively randomized study. Eur J Cardiothorac Surg 2011; 39 (06) 844-852 , discussion 852
• 23 Di Eusanio M, Phan K, Berretta P. et al. Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR): early results from 3343 patients. Eur J Cardiothorac Surg 2018; 54 (04) 768-773
• 24 Andreas M, Coti I, Rosenhek R. et al. Intermediate-term outcome of 500 consecutive rapid-deployment surgical aortic valve procedures. Eur J Cardiothorac Surg 2019; 55 (03) 527-533
• 25 Greason KL, Lahr BD, Stulak JM. et al. Long- term mortality effect of early pacemaker implantation after surgical aortic valve replacement. Ann Thorac Surg 2017; 104 (04) 1259-1264