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DOI: 10.1055/s-0037-1598711
Rapid Deployment Aortic Valve Replacement via Partial Sternotomy: A Reasonable Option in Times of TAVI?
Publication History
Publication Date:
03 February 2017 (online)
Objective: The Edwards Intuity valve (IV) system was designed as a further development of stented bioprostheses for aortic valve replacement (AVR). The application in a minimally invasive setting via partial sternotomy (PS) may represent an alternative to transcatheter aortic valve procedures (TAVI) in selected patients. Herein we present our initial, short-term findings with the IV.
Methods: Between February 2015 and August 2016 a total of 74 IV-implantations were performed at our department (44 isolated AVR, 28 + CABG, 1 + mitral valve reconstruction, 1 + replacement of the ascending aorta (twice + ASD-closure, and twice + LAA-occlusion)). Partial sternotomy was used in 38 of isolated AVR-patients. Mean age of IV patients was 73.3 ± 6.9 years. Hemodynamic parameters and clinical outcome were surveyed during hospitalization and compared with a group of isolated AVR-patients (n = 235) supplied with Edwards pericardial valve (EP) via PS between 8/2009 and 5/2013.
Results: Operative times (aortic cross-clamping, cardiopulmonary bypass and total surgery) were significantly shorter in isolated IV-patients compared with EP (IV: 53 ± 21, 84 ± 30, 160 ± 49 minutes, p < 0.05). The mean valve size was 23.6 ± 2.0 mm in the IV-group compared with 22.9 ± 1.4 mm in EP-patients. Permanent pacemaker implantation was necessary in 3 IV-patients (4%) and 4.7% of EP-patients, p > 0.05. The mean transprosthetic gradient in all IV-patients before discharge was 8.9 ± 2.4 mm Hg. There was no patient with relevant regurgitation (aortic insufficiency>I°) in the IV-group.
ICU- and hospital stay were slightly shorter in the IV-patients, however without significance. Conversion to full sternotomy did not occur in IV-patients (EP 2.1). Re-operation due to bleeding was necessary in 1 patient of the IV-group (1.4%) and in 2.6% of EP-patients. The in-hospital mortality in group EP was 2.6% whereas all IV-patients could be discharged from hospital. The incidence of postoperative complications did not differ significantly between both groups: neurological complications (IV: 2.7 vs. EP: 2.6%), sternal wound infections (2.7% versus 3.0%) and postoperative LCOS (1.4 vs. 2.1%).
Conclusion: In our initial single-center experience the rapid deployment valve represented a safe and feasible option for bioprosthetic aortic valve replacement. It may particularly be considered in high-risk patients with concomitant cardiac procedures and moreover could serve as an interesting alternative for selected TAVI candidates.