Commentary: How long it takes is not as important as how long it lasts

Abstract

Transcatheter aortic valve replacement (TAVR) has been approved for patients with severe aortic stenosis at all levels of risk, and is now performed in more than 700 centers. In fact, annual TAVR volume, for the first time in 2019, exceeded the total number of surgical AVR procedures. [1][2][3][4] At least in part to make the surgical approach more palatable to patient preference compared with TAVR, access through smaller, less invasive hemisternotomy or right thoracotomy incisions has increased, with excellent outcomes. 5 Sutureless or rapid deployment valves have been developed ostensibly to simplify the process of surgical AVR and further facilitate more frequent implantation via these less invasive approaches. 6,7 Unlike with TAVR, the native valve leaflets are removed and the annulus is decalcified, presumably allowing more precise positioning and annular coaptation under vision. Cardiopulmonary bypass and crossclamp times have been approximately 30 minutes shorter than generally seen when implanting stented devices, although whether this difference, for AVR alone or with concomitant procedures, is clinically significant is uncertain. Early hemodynamic performance seems good, especially in smaller valve sizes, perhaps obviating need for annular enlargement procedures in some. 8 Fischlein and colleagues 9 report midterm outcomes at mean follow-up of 3.8 years from 658 patients enrolled to receive the Perceval sutureless valve (LivaNova, PLC, London, United Kingdom) in the multicenter European Cavalier Trial between 2010 and 2013. With mean age of