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Thorac Cardiovasc Surg 2023; 71(07): 519-527
DOI: 10.1055/s-0042-1742686
Original Cardiovascular

Early-Term Results of Rapid-Deployment Aortic Valve Replacement versus Standard Bioprosthesis Implantation Combined with Coronary Artery Bypass Grafting

Zulfugar T. Taghiyev
1   Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
2   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen and Marburg, Giessen, Germany
,
Matthias Bechtel
1   Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
,
Markus Schlömicher
1   Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
,
Dritan Useini 
1   Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
,
Hamid Naraghi Taghi
1   Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
,
Vadim Moustafine
1   Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
,
Justus T. Strauch
1   Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
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Abstract

Objectives Aortic stenosis is highly prevalent among patients with concomitant coronary artery disease. Surgical aortic valve replacement with coronary artery bypass grafting is usually the treatment of choice for patients with severe aortic stenosis and significant coronary disease. The aim of this study was to evaluate the outcome and hemodynamic results of the implantation of rapid-deployment valves (Rapid-Deployment Edwards Intuity Valve System [RDAVR]) versus conventional sutured valves (CSAVR) in combined surgery.

Methods Between January 2012 and January 2017, 120 patients underwent replacement via RDAVR and 133 patients underwent replacement using CSAVR with concomitant coronary bypass grafting. Clinical and echocardiographic data were compared.

Results The mean age was 76 ± 7 for RDAVR patients and 74 ± 6 years for CSAVR patients (p = 0.054); 48% in the RDAVR group were female versus 17% in the CSAVR group (p <0.002). Other characteristics such as diabetes mellitus, body-mass index, chronic obstructive pulmonary disease, nicotine consumption, and extracardiac arteriopathy were similar. Coronary three-vessel disease was more common in the RDAVR group (42.5 vs. 27.8%, p = 0.017). Both mean EuroSCORE II (6.6 ± 5.4 vs. 4.3 ± 3.0, p = 0.001) and STS score (5.4 ± 4.4 vs. 3.4 ± 2.4, p = 0.001) were significantly higher in the RDAVR group. Mean cross-clamp time (82 ± 25 vs. 100 ± 30 minutes, p < 0.001) and cardiopulmonary bypass time (119 ± 38 vs. 147 ± 53 minutes, p < 0.001) were shorter with RDAVR. The mean number of bypass grafts, length of hospital and ICU stays, and mechanical ventilation time were not statistically significant different. Hospital mortality was 2.5% for RDAVR and 9.7% for CSAVR (p = 0.019). There was a similar rate of stroke (5.8 vs. 6.0%, p = 0.990) and postoperative delirium (14.1 vs. 15.8%, p = 0.728). Mean gradients were 8.2 ± 4.1 mm Hg in the RDAVR group vs. 11.3 ± 4.6 mm Hg in the CSAVR group (p = 0.001) at discharge.

Conclusion RDAVR combined with coronary artery bypass grafting (CABG) can be performed extremely safely. Cross-clamp and cardiopulmonary bypass times can be significantly reduced with rapid deployment aortic valve system in the scenario of combined CABG. RDAVR resulted in lower gradients than CSAVR in patients implanted with prostheses of the same size.

Keywords

rapid deployment - valve replacement - CABG

Note

This study was presented at the annual meeting of the German Society of Thoracic and Cardiovascular Surgery, Leipzig, February 19, 2018 (DGTHG-V265…).




Publication History

Received: 14 July 2021

Accepted: 15 December 2021

Article published online:
12 February 2022

© 2022. Thieme. All rights reserved.

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