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

Abstract

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.