Rapid Deployment Aortic Valve Replacement: Excellent Results and Increased Effective Orifice Areas

Rahmanian, Parwis B.; Kaya, Süreyya; Eghbalzadeh, Kaveh; Menghesha, Hruy; Madershahian, Navid; Wahlers, Thorsten

doi:10.1016/j.athoracsur.2017.07.047

Cited by 37 publications

(56 citation statements)

References 23 publications

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“…Surgical aortic valve replacement (SAVR) reduces mortality, provides symptom relief and increases quality of life at subsequent follow-up [1] . Furthermore, continuous improvements in SAVR techniques and new technologies have recently been developed to facilitate the procedure and reduce operative times [2] .…”

Section: Introductionmentioning

confidence: 99%

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National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

Jiménez‐García¹,

Pérez-Farinós²,

Miguel-Díez³

et al. 2020

Braz J Cardiovasc Surg

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Objective: The aims of this study were to examine the incidence and in-hospital outcomes of surgical aortic valve replacement (SAVR) and to identify factors associated with in-hospital mortality (IHM) among patients according to the type of implanted valve used in SAVR. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR listed as a procedure in their discharge report. Results: We identified 86,578 patients who underwent SAVR (52.78% mechanical and 47.22% bioprosthetic). Incidence of SAVR coding increased significantly from 11.95 cases per 100,000 inhabitants in 2001 to 17.92 in 2015 (P<0.001). Age and comorbidities increased over time (P<0.001). There was a significant increase in the frequency of concomitant coronary artery bypass grafting (CABG) and in the use of pacemaker implantation. The use of mechanical SAVR decreased and the use of bioprosthetic valves increased over time. IHM decreased over time (from 8.13% in 2001-05 to 5.39% in 2011-15). Patients who underwent mechanical SAVR had higher IHM than those who underwent bioprosthetic SAVR (7.44% vs. 6%; P<0.05). Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant CABG, and the use of mechanical SAVR (OR 1.67; 95% CI 1.57-1.77). Conclusion: The number of SAVRs performed in Spain has increased since 2001. The use of mechanical SAVR has decreased and the use of bioprosthetic valves has increased over time. IHM has decreased over time for both types of valves and despite a concomitant increase in age and comorbidities of patients during the same period.

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Section: Introductionmentioning

confidence: 99%

“…Previous studies have provided insight into changes in patient demographics, risk factors and outcomes of SAVR [2] . Therefore, it is necessary to study changes in practice over time and to establish outcomes after SAVR to help inform decision making for high-risk patients [3] .…”

Section: Introductionmentioning

confidence: 99%

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

Jiménez‐García¹,

Pérez-Farinós²,

Miguel-Díez³

et al. 2020

Braz J Cardiovasc Surg

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“…27 Furthermore, the excellent post-procedural PGs of the IEV might be the result of slightly oversized valves between two sizes. 28 In consequence, the balloon expansion of an oversized valve can provoke the need of a permanent pacemaker implantation after surgery due to an atrioventricular conduction disturbance. Another potential explanation for the comparable lower post-procedural PGs is the theory that adequately positioned frame with the added skirt of the IEV might keep the outflow tract "open" leading to less turbulence.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with conventional bioprosthetic valves, where pledged-armed sutures are used to tie the valve in the right position and potentially a smaller valve is chosen, RDAV has shown superior hemodynamic characteristics so far. 28,29 Higher transvalvular PGs are usually seen as surrogate parameters for prosthesis-patient mismatch (PPM) independent from the EOA. In our study, the S3V showed higher transvalvular PGs compared with the IEV despite the fact that the transcatheter valve does not have a suture ring, which would decrease the EOA of any prosthetic valve.…”

Section: Discussionmentioning

confidence: 99%

SAVR versus TAVI: What about the Hemodynamic Performance? An In Vivo and In Vitro Analysis

Eghbalzadeh

Rahmanian

Giese

et al. 2019

Thorac Cardiovasc Surg

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Background Surgical aortic valve replacement (SAVR) is nowadays discussed whether it remains the gold standard of treatment. In the last decade, there has been a tremendous increase in transcatheter aortic valve implantation (TAVI) due to the growing expertise and excellent results of the catheter-based approach. We, therefore, retrospectively compared the rapid deployment valve (RDV), the Edwards Intuity valve (IEV), with the Edwards Sapien 3 (S3V) with regard to post-procedural hemodynamics. Methods A total of 246 patients treated with TAVI or SAVR between February 2009 and November 2015 were included. One-hundred twenty-five patients were analyzed in the SAVR group and compared with 121 patients undergoing TAVI. Transvalvular pressure gradients (PGs) and the incidence and extent of aortic regurgitation (AR) were compared post-procedurally by echocardiography for each valve size. In vitro hemodynamics were analyzed by placing both valves into an aortic silicone phantom connected to a pulsatile flow pump and measured using phase-contrast magnetic resonance imaging (4D flow MRI). Results Post-procedurally, mean transvalvular PGs for the 23 mm valves were 9 (7;11.5) versus 13 (9;18) (p < 0.001), whereas maximum PGs were 16.5 (14;22) versus 25.5 mm Hg (17.5;34) (p < 0.001) in IEV and S3V patients, respectively. The 21 mm IEV showed significantly lower transvalvular PGs compared with the 23 mm S3V: mean PGs: 11 (8;13) versus 13 (9;18) (p < 0.05); maximum PG: 19.5 (13;24) versus 25.5 (18;34) mm Hg (p < 0.05). Analysis revealed significantly lower post-procedural transvalvular PGs for larger valves sizes. With respect to AR, the incidence of AR was significantly lower in IEV group (p < 0.05). In vitro velocities and turbulent kinetic energy values showed similar results between both valves. Conclusion Implanted RDVs presented a lower incidence of paravalvular regurgitation and were associated with significantly lower post-procedural transvalvular PGs, especially for small valve sizes. Our data might support the application of rapid deployment aortic valves in patients with small aortic annulus in the TAVI era.

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“…Data published on the comparison between RD-AVR and SAVR underline the benefits of RD-AVR in terms of operative time reduction, CBP duration and increased effective orifice area and consequent lower postoperative transvalvular gradient [19] . The most common complications reported in the case of RD-AVR are higher incidence of pacemaker implantation, postoperative stroke and residual aortic regurgitation [20] , while the most common complications reported in the case of standard procedure tend to be exclusively surgery related as major bleeding or acute renal failure [21] .…”

Section: Discussionmentioning

confidence: 99%

Bridging aortic valve surgery to 21st century: what can a surgeon do?

D'Abramo¹,

Ferrante²,

Guimarães³

et al. 2019

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Aortic valve stenosis is the most clinically relevant valvular heart disease in the elderlies. Surgical aortic valve replacement (SAVR) represented, for decades, the standard of care for the treatment of severe aortic stenosis. Although SAVR still represents a valid option in this clinical scenario, transcatheter aortic valve implantation proved to be superior to medical therapy and comparable to SAVR in several randomized trials in patients at high or intermediate operative risk. At the same time, the growing aging population carrying on greater morbidities and high risk profiles has led to the development of minimally invasive technologies, as rapid deployment aortic valve replacement or Sutureless, to minimize surgical impact on patients. The Heart Team is nowadays tasked to determine the best option tailored for each patient considering patient-related factors and mastering all the surgical options in terms of both different techniques and types of available valves. Nevertheless, some open issues need to be already answered as: which has the longest durability, which the lower complication rate and the lower overall mortality. The aim of this review is to briefly resume the main features of these different options and explore what kind of open questions these newer-generation prosthetic valves and delivery devices carry.

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Rapid Deployment Aortic Valve Replacement: Excellent Results and Increased Effective Orifice Areas

Cited by 37 publications

References 23 publications

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

SAVR versus TAVI: What about the Hemodynamic Performance? An In Vivo and In Vitro Analysis

Bridging aortic valve surgery to 21st century: what can a surgeon do?

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