Rapid-deployment Valve versus Conventional Valves in Aortic Valve Replacement in Intermediate-risk Patients
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v3i1.3457
Abstract
Background: Aortic valve replacement (AVR) in intermediate-risk (IR) patients is particularly challenging when determining the type of prosthesis to use. Rapid-deployment valves (RD-V) are emerging as a potential alternative in this patient population. Objectives: To compare early mortality, postoperative complications, and transvalvular hemodynamic parameters between AVR with conventional valves and RD-V in IR patients. Methods: We conducted a retrospective observational study of consecutive IR patients (STS-PROM score 4-8) undergoing AVR with conventional prostheses and RD-V between 2007 and 2023. Results: A total of 205 patients were included (140 AVR vs. 65 RD-V). Surgical risk was similar in both groups (STS-PROM 5.07 % vs. 5.7 % respectively, p = 0.210). The minimally invasive approach was more common in the RD-V group (32.3% vs. 0.7%, p < 0.001). The cardiopulmonary bypass time and aortic cross-clamp time were significantly shorter in the RD-V group (134.5 vs. 100 min and 104 vs. 73 min, respectively, p < 0.001). There was a trend to lower incidence of pacemaker implantation in the conventional valve group (4.3% vs. 10.8%, p = 0.075). There were no significant differences in postoperative complications, and a strong trend to lower 30-day mortality with RD-V (0% vs. 5.7% for conventional valves, p = 0.057). The mean postoperative gradient across the prosthesis was significantly lower in the RD-V group (7.90 ± 3.3 mm Hg vs. 12.74 ± 6.07 mm Hg, p < 0.001). There were no differences in the incidence of valve thrombosis or prosthetic endocarditis. Conclusions: Rapid-deployment valves demonstrated trend to lower mortality, shorter cardiopulmonary bypass time and aortic cross-clamp time, improved hemodynamic profile, and were easier to implant via a minimally invasive approach.
Keywords
biological valves; aortic valve replacement; intermediate risk; rapid deployment valves
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[3] Smith CR, Leon MB, Mack MJ. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187-2198.
[4] Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-2791.
[5] Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Fleisher LA, et al. 2017 AHA/ACC focused update of the 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 clinical practice guidelines. J Am Coll Cardiol. 2017;70(2):252-289.
[6] Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodhali SK, et al. Transcatheter or surgical aortic valve replacement in intermediate-risk patients. N Eng J Med. 2016;374(17):1609-1620.
[7] Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M, et al.; SURTAVI Investigators. Surgical or transcatheter aortic-valve. Replacement in Intermediate-Risk Patients. N Engl J Med. 2017;376(14):1321-1331.
[8] D'Onofrio A, Salizzoni S, Rubino AS, Besola L, Filippini C, Alfieri O, et al. The rise of new technologies for aortic valve stenosis: a comparison of sutureless and transcatheter aortic valve implantation. J Thorac Cardiovasc Surg. 2016;152(1):99-109.
[9] Fischlein T, Meuris B, Hakim-Meibodi K. The sutureless aortic valve at 1 year: a large multicenter cohort study. J Thorac Cardiovasc Surg. 2016;151(6):1617-1626.
[10] Fortunato GA, Marenchino R, Cirio S, et al. Reemplazo valvular aórtico en pacientes de riesgo intermedio. Rev. argent. cardiol. 2018;86(2):116-120.
[11] Muneretto C, Solinas M, Folliguet T, Di Bartolomeo R, Repossini A, Laborde F, et al. Sutureless versus transcatheter aortic valves in elderly patients with aortic stenosis at intermediate risk: A multi-institutional study. J Thorac Cardiovasc Surg. 2022;163(3):925–935.e5.
[12] Zhang K, Pan XD, Dong SB, Zheng J, Xu SD, Liu YM, et al. Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection. J Int Med Res. 2020;48(11):300060520968450.
[13] Jovanovic M, Zivkovic I, Jovanovic M, Bilbija I, Petrovic M, Markovic J, et al. Economic justification analysis of minimally invasive versus conventional aortic valve replacement. Int J Environ Res Public Health. 2023;20(3):2553.
[14] Kocher AA, Laufer G, Haverich A, Shrestha M, Walther T, Misfeld M, 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(1):110-116.
[15] Romano MA, Koeckert M, Mumtaz MA, Slachman FN, Patel HJ, Chitwood WR Jr, et al. Permanent pacemaker implantation after rapid deployment aortic valve replacement. Ann Thorac Surg. 2018;106(3):685-690.
[16] Matthews IG, Fazal IA, Bates MG, Turley AJ. In patients undergoing aortic valve replacement, what factors predict the requirement for permanent pacemaker implantation? Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):475-479
[17] Coti I, Schukro C, Drevinja F, Haberl T, Kaider A, Kocher A, et al. Conduction disturbances following surgical aortic valve replacement with a rapid-deployment bioprosthesis. J Thorac Cardiovasc Surg. 2021 Sep;162(3):803-811.
[18] Santarpino G, Berretta P, Fischlein T, Carrel TP, Teoh K, Misfeld M, et al. Operative outcome of patients at low, intermediate, high and ‘very high' surgical risk undergoing isolated aortic valve replacement with sutureless and rapid deployment prostheses: results of the SURD-IR registry. Eur J Cardiothorac Surg. 2019;56(1):38-43.
[19] Borger MA, Moustafine V, Conradi L, Knosalla C, Richter M, Merk DR, et al. A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement. Ann Thorac Surg. 2015;99(1):17-25.
[20] Haverich A, Wahlers TC, Borger MA, Shrestha M, Kocher AA, Walther T, et al. Three-year hemodynamic performance, left ventricular mass regression, and prosthetic-patient mismatch after rapid deployment aortic valve replacement in 287 patients. J Thorac Cardiovasc Surg. 2014;148(6):2854-2860.
[21] Andreas M, Wallner S, Habertheuer A, Rath C, Schauperl M, Binder T, et al. Conventional versus rapid-deployment aortic valve replacement: a single-centre comparison between the Edwards Magna valve and its rapid-deployment successor. Interact CardioVasc Thorac Surg. 2016;22(6):799-805.
[22] Tabata M, Shibayama K, Watanabe H, Sato Y, Fukui T, Takanashi S. Simple interrupted suturing increases valve performance after aortic valve replacement with a small supra-annular bioprosthesis. J Thorac Cardiovasc Surg. 2014;147(1):321-325.
[23] Bourguignon T, Bouquiaux-Stablo AL, Candolfi P, Mirza A, Loardi C, May MA, et al. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Ann Thorac Surg. 2015;99(3):831-837.
Copyright © 2025 Germán A. Fortunato, Tomás D'Angelo, Guido Busnelli, Carlos A. Tamara, Nicolás Sultano, Jacinto Theaux, Patricio E spector, Florencia Valdecantos, Ricardo Posatini, Juan Bianco, Emiliano Rossi, Vadim Kotowicz
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