Combined valve surgery with sutureless and rapid-deployment aortic valve replacement: when and why

Nguyen, Stéphanie; Cohn, Benjamin M.; Nguyen, Tom C.

doi:10.21037/acs-2019-surd-11

Cited by 2 publications

(3 citation statements)

References 10 publications

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“…Measurement of the AMD enables safe deployment of the sutereless prosthesis, avoiding prothesis interference and supra-annular mispositioning. In general, an AMD of 5 mm has been considered as a safe measurement when considering the deployment of SU-AVR with concomitant mitral valve prostheses [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Conventional Biological versus Sutureless Aortic Valve Prostheses in Combined Aortic and Mitral Valve Replacement

Szczechowicz

Rad

Amanov

et al. 2023

Life

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Background: Sutureless aortic valve prostheses have proven to provide a significant decrease in procedural, cardiopulmonary bypass and cross-clamp time, leading to a significant reduction in mortality risk in elderly high-risk cohorts. In this study, we sought to review our institutional experience on the sutureless aortic valve replacement (SU-AVR) and the concomitant mitral valve replacement (SMVR), comparing the combined conventional surgical aortic valve replacement (SAVR) with SMVR. Methods and Material: Between March 2018 and July 2022, 114 consecutive patients underwent a combined aortic and mitral valve replacement at our institution. We stratified the patients according to the operative procedures into two groups and matched them 1:2: Group 1 underwent a combined conventional SAVR and SMVR (n = 46), and Group 2 included combined SU-AVR with Perceval prosthesis and SMVR (n = 23). Results: No significant differences in the preoperative characteristics were present. SU-AVR combined with SMVR demonstrated excellent haemodynamic performance, comparable to that of SAVR plus SMVR, with median postoperative gradients over the aortic valve of 4 mmHg (IQR 3.0–4.0) in Group 1 and 4 mmHg (IQR 3.0–4.0) in Group 2 (p = 0.67). There was no significant difference in the occurrence of postoperative major adverse events such as death, stroke, myocardial infarction and kidney failure between the groups. There was also no significant difference in the permanent pacemaker implantation rate, paravalvular leakage or valve dislocation. We also could not detect any significant difference in postoperative mortality between the groups. Conclusions: SU-AVR has proven to be a reliable alternative to conventional valve prostheses in patients with multivalve disease undergoing combined aortic and mitral valve replacement, offering shorter procedural time and outstanding hemodynamic performance compared to the conventional surgical method.

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Section: Discussionmentioning

confidence: 99%

Conventional Biological versus Sutureless Aortic Valve Prostheses in Combined Aortic and Mitral Valve Replacement

Szczechowicz

Rad

Amanov

et al. 2023

Life

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“…Sufficient decalcification can mitigate the incidence of PPI and PVL compared to TAVR as displacement of a calcified valve and annulus in TAVR would not happen in SRDV after removal of the leaflets and decalcification. 87 , 88 Thus, decalcification is generally preferred whenever feasible. Since it is not mandatory to decalcify the entire annulus to enable suturing, it can be time-saving in a hostile aortic root or redo cases.…”

Section: Technical Consideration In Specific Situationsmentioning

confidence: 99%

“…SRDV should be avoided if there is a complex calcification from the annulus to STJ, as this may increase the incidence of stroke from embolization, PVL, and PPI. 88 Type 0 BAV should also be avoided because complex additional procedures are not reproducible and offset the time-saving advantages of SRDV. SRDV can also be utilized in patients with infective endocarditis, 89 however, it should be noted that annular abscess or destruction may compromise valve fitting.…”

Section: Technical Consideration In Specific Situationsmentioning

confidence: 99%

Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations

Sakata¹,

Pena²,

Ohira³

2023

VHRM

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Sutureless or rapid deployment valves in the setting of aortic valve replacement (AVR) is an emerging surgical technique using the transcatheter valve technology, which may lead to reduction in cross-clamp time and potentially better hemodynamics compared to a stented bioprosthetic valve. The absence of subannular pledgets results to excellent hemodynamic performance with reduced turbulent flow and larger effective orifice area. However, complications from both surgical and transcatheter AVR may still occur and impact survival. The incidence of paravalvular leakage and permanent pacemaker implantation are not low. Although technical modifications can improve these outcomes, there is a learning curve effect. Therefore, technical and anatomical considerations as well as better patient selection are paramount for better outcomes. In this review, we discuss the use of sutureless or rapid deployment valves in setting of (1) complex procedures, (2) minimally invasive AVR, and (3) small aortic annulus. The advantage of sutureless or rapid deployment valves in terms of mortality remains to be clarified; therefore, it is necessary to accumulate long-term outcomes in an appropriate patient cohort.

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Combined valve surgery with sutureless and rapid-deployment aortic valve replacement: when and why

Cited by 2 publications

References 10 publications

Conventional Biological versus Sutureless Aortic Valve Prostheses in Combined Aortic and Mitral Valve Replacement

Conventional Biological versus Sutureless Aortic Valve Prostheses in Combined Aortic and Mitral Valve Replacement

Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations

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