Minimally Invasive vs Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses

D’Onofrio, Augusto; Tessari, Chiara; Lorenzoni, Giulia; Cibin, Giorgia; Martinelli, Gian Luca; Alamanni, Francesco; Polvani, Gianluca; Solinas, Marco; Massetti, Massimo; Merlo, Maurizio; Vendramin, Igor; Eusanio, Marco Di; Mignosa, Carmelo; Milardi, Domenico; Russo, Claudio; Rinaldi, Mauro; Pacini, Davide; Salvador, Loris; Antona, Carlo; Maselli, Daniele; Paulis, Ruggero De; Luzi, Giampaolo; Alfieri, Ottavio; Filippo, Carlo Maria De; Portoghese, Michele; Musumeci, Francesco; Colli, Andrea; Gregori, Darío; Gerosa, Gino

doi:10.1016/j.athoracsur.2020.06.150

Cited by 4 publications

(9 citation statements)

References 28 publications

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“…The recent introduction in the surgical armamentarium of SB clearly demonstrates that old ideas can be effectively turned into modern concepts in the manufacturing of cardiac valve prostheses [ 29 ]. SBs have demonstrated in large series and multicenter studies that they provide satisfactory results with low operative mortality, constantly improving outcomes, even when associated procedures are performed, and promising medium-term data [ 30 , 31 , 32 ]. Similar results have been reported with RDBs with regard to safety, hemodynamic performance, and favorable outcomes [ 33 , 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

Vendramin

Lechiancole

Piani

et al. 2021

JCDD

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Sutureless and rapid-deployment bioprostheses have been introduced as alternatives to traditional prosthetic valves to reduce cardiopulmonary and aortic cross-clamp times during aortic valve replacement. These devices have also been employed in extremely demanding surgical settings, as underlined in the present review. Searches on the PubMed and Medline databases aimed to identify, from the English-language literature, the reported cases where both sutureless and rapid-deployment prostheses were employed in challenging surgical situations, usually complex reoperations sometimes even performed as bailout procedures. We have identified 25 patients for whom a sutureless or rapid-deployment prosthesis was used in complex redo procedures: 17 patients with a failing stentless bioprosthesis, 6 patients with a failing homograft, and 2 patients with the failure of a valve-sparing procedure. All patients survived reoperation and were reported to be alive 3 months to 4 years postoperatively. Sutureless and rapid-deployment bioprostheses have proved effective in replacing degenerated stentless bioprostheses and homografts in challenging redo procedures. In these settings, they should be considered as a valid alternative not only to traditional prostheses but also in selected cases to transcatheter valve-in-valve solutions.

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Section: Discussionmentioning

confidence: 99%

Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

Vendramin

Lechiancole

Piani

et al. 2021

JCDD

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“…As experience and technology grow, 5,14 the contemporary outcomes of minimally invasive approach should be investigated. Herein, we aimed to incorporate the most recent data and report the contemporary outcomes of minimally invasive approaches compared to conventional FS approach for SAVR.…”

Section: Introductionmentioning

confidence: 99%

“…Minimally invasive approaches have attracted surgeons and patients for the potential benefits of better cosmesis, less pain, early mobilization, fewer respiratory complications, and patients' satisfaction, shorter hospital length of stay (LOS), fewer blood transfusion requirements, and fewer sternal wound complications. [2][3][4][5] Although the outcomes have been investigated between these minimally invasive approaches and conventional full sternotomy (FS) approach, their results were inconsistent possibly due to study design, selection bias, and different experience levels of surgeons or institutions. 4,6,7 Previously, two meta-analyses investigated the outcomes after SAVR between minimally invasive approaches and FS in 2018 and 2020.…”

Section: Introductionmentioning

confidence: 99%

“…As experience and technology grow, 5,14 the contemporary outcomes of minimally invasive approach should be investigated.…”

Section: Introductionmentioning

confidence: 99%

“…With the advent of facilitating technologies, minimally invasive approaches have been introduced to SAVR including mini‐sternotomy (MS) and right mini‐thoracotomy (RMT). Minimally invasive approaches have attracted surgeons and patients for the potential benefits of better cosmesis, less pain, early mobilization, fewer respiratory complications, and patients’ satisfaction, shorter hospital length of stay (LOS), fewer blood transfusion requirements, and fewer sternal wound complications 2–5 . Although the outcomes have been investigated between these minimally invasive approaches and conventional full sternotomy (FS) approach, their results were inconsistent possibly due to study design, selection bias, and different experience levels of surgeons or institutions 4,6,7 .…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive versus conventional aortic valve replacement: The network meta‐analysis

Ogami

Yokoyama

Takagi

et al. 2022

Journal of Cardiac Surgery

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Background Outcome comparisons after surgical aortic valve replacement (SAVR) with minimally invasive approaches including mini‐sternotomy (MS) and right mini‐thoracotomy (RMT) and full sternotomy (FS) have been conflicting. Furthermore, the synthesis of mid‐term mortality has not been performed. Methods MEDLINE and EMBASE were searched through April 2022 to identify propensity score matched (PSM) studies or randomized controlled trial (RCT) which compared outcomes following SAVR among three incisional approaches: FS, MS, or RMT. The network analysis was performed to compare these approaches with random effects model. Mid‐term mortality was defined as 1‐year mortality. Results A total of 42 studies met the inclusion criteria enrolling 14,925 patients. RCT and PSM were performed in 13 and 29 studies, respectively. The operative mortality was significantly lower with MS compared to FS (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.41–0.90, p = .01, I2 = 25.8%) or RMT (RR: 0.51, 95% CI: 0.27–0.97, p = .03, I2 = 25.8%). RMT had significantly higher risk of reoperation for bleeding compared to MS (RR: 1.65, 95% CI: 1.18–2.30, p = .003, I2 = 0%). Hospital length of stay was significantly shorter with MS compared to FS (mean difference: −0.89 days, 95% CI: −1.58 to −0.2, p = .01, I2 = 95.5%) while it was equivocal between FS and RMT. The mid‐term mortality was similar among the three approaches. Conclusions While mid‐term mortality was comparable among approaches, MS may be a safe and potentially more effective approach than FS and RMT for SAVR in the short term.

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Standard versus rapid-deployment aortic valve replacement and concomitant myocardial revascularization: 5-year bi-centre clinical outcomes

Bottio

Piperata

Guariento

et al. 2022

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Clinical outcomes of two generations of pericardial bioprostheses in concomitant aortic valve and coronary artery bypass graft surgery were analyzed. METHODS Patients were recruited from two European centers and divided into 2 groups based on the type of aortic bioprosthesis used: Edwards Intuity EliteTM rapid deployment bioprostheses or standard Edwards Magna Ease (Edwards Lifesciences, Corporation, Irvine, California, US). A propensity score weighting approach was used for data analysis. RESULTS 285 patients were included: 144 (50.5%) in the Rapid Deployment group and 141 (49.5%) in the Magna Ease group. Thirty-day mortality was 2.8% (Rapid Deployment) and 5% (Magna Ease) (P = 0.089). Significantly shorter times of aortic cross-clamp and cardiopulmonary bypass were observed in the Rapid Deployment cohort [94 vs 120 min; (P < 0.001); 128 vs 160 min (P < 0.001)]. The Rapid Deployment group was associated with a lower median transvalvular gradient at discharge and follow-up (both P < 0.001). However, 5-year survival was not different, being 93% in Rapid Deployment patients and 91% in the Magna Ease group [HR 0.89 (CI 95%:0.38–2.09), P = 0.784]. The 5-year cumulative incidence of combined events (including percutaneous coronary interventions, endocarditis, thromboembolic events, rehospitalizations, and bleeding) favored the Magna Ease group [16.1% (Rapid Deployment) vs 7.3% (Magna Ease), [HR 2.38 (CI 95%:1.03–5.52), P = 0.043]. However, this turned similar when the Cox model analysis was adjusted for revascularization variables (P = 0.067). CONCLUSIONS Rapid deployment and Magna Ease pericardial bioprostheses used in concomitant aortic valve replacement and coronary artery revascularization provide equivalent clinical and haemodynamic 5-year outcomes, despite constant lower transvalvular gradients and shorter surgical operating times observed with rapid deployment technology.

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Minimally Invasive vs Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses

Cited by 4 publications

References 28 publications

Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

Minimally invasive versus conventional aortic valve replacement: The network meta‐analysis

Standard versus rapid-deployment aortic valve replacement and concomitant myocardial revascularization: 5-year bi-centre clinical outcomes

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