Surgical aortic valve replacement with new-generation bioprostheses: Sutureless versus rapid-deployment

Case report describing late balloon dilatation as a treatment for paravalvular leak with intuity elite rapid deployment valve

“…This case demonstrates the successful percutaneous treatment of paravalvular leak present following implantation of an Edwards Intuity Elite valve. Rapid deployment and sutureless prosthesis have become widely used in the recent years, largely due to ease of implantation (resulting in shorter cardiopulmonary bypass and aortic cross‐clamp times) as well as excellent hemodynamics . In addition, they have been used in many centers to facilitate minimal access surgery, which may be associated with faster recovery, shorter hospital stay, and improved survival as compared to full sternotomy AVR .…”

“…Use of rapid deployment and sutureless bioprostheses has become widespread, as a result of their ease of implantation, excellent hemodynamics, and benefits derived from minimal access surgery . Paravalvular leak is a reported complication of the use of these devices and requires close monitoring .…”

Commentary: The unspoken truth about ease of use

“…Novel sutureless (Perceval; LivaNova PLC, London, United Kingdom) and rapid-deployment (Intuity; Edwards Lifesciences, Irvine, Calif) valves capitalize on the importance of ease of use, and both are now available in the United States. 1,2 In their article published in this issue of the Journal, D'Onofrio and colleagues 3 have compared outcomes in patients receiving these self-anchoring valves in a real-world European experience (Intuity data from an Italian registry and Perceval data from 3 other centers). Greedy-matching on 16 variables modeled for receiving an Intuity valve yielded 117 matched pairs.…”

“…Although they were not compared with standard sutured surgical aortic valve replacement, both self-anchoring valves provided the benefit of considerably shorter crossclamp times compared with all aortic devices in the Society of Thoracic Surgeons database. 3 The Perceval saved 20 more minutes than the Intuity, 10 minutes for isolated aortic valve replacement, and 15 minutes for a minimally invasive approach. Now more than ever, we need to carefully consider specific device characteristics in the context of an individual patient's situation.…”

“…4 Average peak and mean gradients in that series were 26 mm Hg and 14 mm Hg, respectively, higher than the average gradients of either valve in the article by D'Onofrio and colleagues 3 (22/12 mm Hg for Perceval vs 20/10 mm Hg for Intuity). 3 These easier-to-use valves do not compromise hemodynamic performance and may even enhance it. More follow-up will demonstrate whether this also translates to better durability than the standard surgical bioprostheses.…”