Hemodynamic performance and clinical consequences of aortic valve replacement with 21mm-size pericardial bioprosthesis

Abstract Background and objectives Sutureless aortic valves aim to achieve better outcomes and to aid and facilitate the minimally invasive aortic valve replacement procedure by tackling the issue of cross clamp time, which is an independent predictor of post-operative outcomes especially in patients with serious comorbidities. (2, 3) By reducing the number of sutures, the time for sutures placement is reduced. (1) Our Meta-analysis tries to assess the safety and hemodynamic performance of the sutureless aortic valve prosthesis’s in an attempt to ascertain their benefits as a viable alternative to current established measures. Methodology From their beginnings to February 2017, electronic searches were conducted using six databases. Relevant studies using commercially accessible suture-free valves to replace the aortic valve have been recognized. Based on the predefined endpoints, data were collected and analyzed. Results FC For incorporation in qualitative and quantitative analyses, twenty-four studies were recognized, with a total number of 5073 patients undergoing sutureless aortic valve replacement (SU-AVR). Mortality incidence at 30 days and 12 months follow-ups were 2.5% and 2.7%, respectively, while the incidence of thromboembolic events (1.6%) and paravalvular leak (PVL) (0.5%) were acceptable. Conclusion Current available evidence indicates that sutureless aortic valve replacement is a safe operation showing low mortality and complication rates, with satisfactory hemodynamic performance.

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Minimally Invasive Implantation of the EDWARDS INTUITY Rapid Deployment Aortic Valve via a Right Minithoracotomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000158 ◽

2015 ◽

Vol 10 (3) ◽

pp. 215-217 ◽

Cited By ~ 2

Author(s):

Aristidis Lenos ◽

Anno Diegeler

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Pacemaker Implantation ◽

Paravalvular Leak ◽

Hemodynamic Performance ◽

Invasive Techniques ◽

Rapid Deployment

During the past decade, many surgeons have focused their interest on the development and improvement of minimally invasive techniques for aortic valve replacement. Although the minimally invasive approaches for the treatment of mitral valve disease have been standardized, the preferred route for aortic valve replacement remains a matter of debate. Access through a right minithoracotomy avoids opening the sternum; however, it requires a greater surgical ability and a learning period, even for experienced surgeons. This enhances the role of sutureless prostheses because these devices are associated with easier placement, excellent hemodynamic performance, and acceptable rates of pacemaker implantation and paravalvular leak. Herein, we report a series of 10 consecutive patients who received an EDWARDS INTUITY rapid deployment valve (Edwards Lifesciences, Irvine, CA USA) by a right minithoracotomy.

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Easy Placement of Annular Sutures during Minimally Invasive Aortic Valve Replacement

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000365 ◽

2017 ◽

Vol 12 (3) ◽

pp. 227-229 ◽

Cited By ~ 1

Author(s):

Toshinori Totsugawa ◽

Arudo Hiraoka ◽

Kentaro Tamura ◽

Hidenori Yoshitaka ◽

Taichi Sakaguchi

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Left Ventricular ◽

Surgical Field ◽

Coronary Cusp ◽

Hemodynamic Performance ◽

The Right ◽

Right Coronary Cusp

Placing annular sutures at the right coronary cusp is difficult during minimally invasive aortic valve replacement. We propose the partial everting mattress method, whereby a prosthetic valve is implanted ina supra-annular position at the left coronary and noncoronary cusps, with pledgets on the left ventricular side, but in an intra-annular position at the right coronary cusp, with pledgets on the aortic side. Needles can be grasped in forehand pass at all three coronary cusps. Our method enables easy placement of annular stitches even in the small surgical field, without adversely influencing the hemodynamic performance of the prosthesis.

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Three-year hemodynamic performance, left ventricular mass regression, and prosthetic-patient mismatch after rapid deployment aortic valve replacement in 287 patients

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2014.07.049 ◽

2014 ◽

Vol 148 (6) ◽

pp. 2854-2861 ◽

Cited By ~ 48

Author(s):

Axel Haverich ◽

Thorsten C. Wahlers ◽

Michael A. Borger ◽

Malakh Shrestha ◽

Alfred A. Kocher ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Left Ventricular Mass ◽

Valve Replacement ◽

Left Ventricular ◽

Ventricular Mass ◽

Hemodynamic Performance ◽

Rapid Deployment

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Early Outcomes of Isolated Aortic Valve Replacement Through Right Anterior Minithoracotomy Using the Latest-Generation Biological Prosthesis

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520975889 ◽

2020 ◽

pp. 155698452097588

Author(s):

Hossein Amirjamshidi ◽

Courtney Vidovich ◽

Ariana Goodman ◽

Peter A. Knight

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Effective Orifice Area ◽

Term Survival ◽

Invasive Approach ◽

Intermediate Outcomes ◽

Hemodynamic Performance

Objective The aim of this study is to evaluate early and intermediate outcomes and hemodynamics of the latest-generation Trifecta valve implanted using right anterior minithoracotomy. Methods We performed a single-center, retrospective, observational study including 175 individuals who underwent isolated minimally invasive aortic valve replacement with the latest-generation Trifecta valves through a right anterior minithoracotomy between January 2016 and January 2019. Exclusion criteria for follow-up echocardiographic study included concomitant procedures, conversion to median sternotomy, and nonsurvival during the index admission. Analyses addressed implantation safety, 30-day and intermediate-term survival and hemodynamic performance of the valves. Results Overall, patients were followed with duration ranging from 0.5 to 3 years. Early (<30 days) mortality occurred in 2 patients (1.1%), and there were 9 (5.1%) late (>30 days) deaths. Early thromboembolic events and postoperative bleeding requiring reoperation occurred at a rate of 4.0% ( n = 7) and 6.2% ( n = 11), respectively. Overall in 175 patients who met inclusion criteria for the follow-up echocardiography study, mean gradients across all valve sizes were 41.3 ± 14.9 (standard deviation) mm Hg preoperatively and remained low at 7.2 ± 3.9 mm Hg with mean effective orifice area of 1.8 ± 0.5 cm2 on the last follow-up echo. There was 1 case of infective prosthetic endocarditis, which did not require valve explant. There were no reoperations due to valve-related problems during the study period. Conclusions This is the largest series reporting on outcomes of the latest-generation Trifecta valve implanted using right anterior minithoracotomy. Our results demonstrate that this valve can be safely implanted via a minimally invasive approach with excellent early and intermediate outcomes and hemodynamic performance.

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