A new technique that prevents paravalvular leakage after aortic valve replacement using a rapid-deployment valve system.
valve repair/replacement
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
11
01
2021
accepted:
31
01
2021
pubmed:
31
3
2021
medline:
11
6
2021
entrez:
30
3
2021
Statut:
ppublish
Résumé
We report our 1-year single-center experience of a new technique of aortic valve replacement using a rapid-deployment valve (RD-AVR) to avoid postoperative complications. We also report the unexpected pitfalls and handling techniques that we have seen in past cases. We performed aortic valve replacement on 38 patients between May 2019 and April 2020. Their mean age was 74 years. The primary outcomes were in-hospital mortality and short-term results during a 1-year follow-up period, while the secondary outcomes were related to prosthetic valve function, especially paravalvular leakage (PVL). We further analyzed the relationship between the new technique and its outcomes. The mean operative time was 196 min. There were no in-hospital deaths, and the mean duration of postoperative hospital stay was 11.8 days. Valvular measurements using three-dimensional computed tomography were larger and more accurate than those measured using ultrasonic echocardiography. Postoperative RD-AVR prosthetic valve function was excellent. However, PVL occurred in four cases 1 week and 1 year postoperatively and regurgitation did not improve. A gap associated with PVL was identified below the right-noncoronary commissure. To prevent PVL, we additionally stitched this gap in the later 18 cases; there was no case of PVL and no new pacemaker implantation in these cases. PVL is more likely to occur if there is a gap below the R-N commissure, especially in cases with a large annulus; therefore, applying an additional stitch to the R-N commissure is extremely useful.
Sections du résumé
BACKGROUND
BACKGROUND
We report our 1-year single-center experience of a new technique of aortic valve replacement using a rapid-deployment valve (RD-AVR) to avoid postoperative complications. We also report the unexpected pitfalls and handling techniques that we have seen in past cases.
METHODS
METHODS
We performed aortic valve replacement on 38 patients between May 2019 and April 2020. Their mean age was 74 years. The primary outcomes were in-hospital mortality and short-term results during a 1-year follow-up period, while the secondary outcomes were related to prosthetic valve function, especially paravalvular leakage (PVL). We further analyzed the relationship between the new technique and its outcomes.
RESULTS
RESULTS
The mean operative time was 196 min. There were no in-hospital deaths, and the mean duration of postoperative hospital stay was 11.8 days. Valvular measurements using three-dimensional computed tomography were larger and more accurate than those measured using ultrasonic echocardiography. Postoperative RD-AVR prosthetic valve function was excellent. However, PVL occurred in four cases 1 week and 1 year postoperatively and regurgitation did not improve. A gap associated with PVL was identified below the right-noncoronary commissure. To prevent PVL, we additionally stitched this gap in the later 18 cases; there was no case of PVL and no new pacemaker implantation in these cases.
CONCLUSIONS
CONCLUSIONS
PVL is more likely to occur if there is a gap below the R-N commissure, especially in cases with a large annulus; therefore, applying an additional stitch to the R-N commissure is extremely useful.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2225-2232Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Thaden JJ, Nkomo VT, Enriquez-Sarano M. The global burden of aortic stenosis. Prog Cardiovasc Dis. 2014;56:565-571.
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368:1005-1011.
Glauber M, Miceli A. Minimally invasive aortic valve replacement with sutureless valve is the appropriate treatment option for high-risk patients and the “real alternative” to transcatheter aortic valve implantation. J Thorac Cardiovasc Surg. 2016;151:610-613.
Coti I, Haberl T, Scherzer S, et al. Outcome of rapid deployment aortic valves: long-term experience after 700 implants. Ann Cardiothorac Surg. 2020;9:314-321.
Sadri V, Bloodworth CH, 4th, Madukauwa-David ID, Midha PA, Raghav V, Yoganathan AP. A mechanistic investigation of the Edwards INTUITY Elite valve's hemodynamic performance. Gen Thorac Cardiovasc Surg. 2020;68:9-17.
Miceli A, Berretta P, Fiore A, et al. Sutureless and rapid deployment implantation in bicuspid aortic valve: results from the sutureless and rapid-deployment aortic valve replacement international registry. Ann Cardiothorac Surg. 2020;9:298-304.
Ferrari E, Siniscalchi G, Tozzi P, von Segesser L. Aortic annulus stabilization technique for rapid deployment of aortic valve replacement. Innovations (Phila). 2015;10:360-362.
Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366:1686-1695.
Popma JJ, Adams DH, Reardon MJ, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at an extreme risk of surgery. J Am Coll Cardiol. 2014;63:1972-1981.
Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: a meta-analysis and systematic review of literature. J Am Coll Cardiol. 2013;61:1585-1595.
Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet. 2016;387:2218-2225.
Hayashida K, Lefèvre T, Chevalier B, et al. Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation JACC Cardiovasc Interv. 2012;5:1247-1256.
Feldman TE, Reardon MJ, Rajagopal V, et al. Effect of mechanically expanded vs. self-expanding transcatheter aortic valve replacement on mortality and major adverse clinical events in high-risk patients with aortic stenosis: the REPRISE III randomized clinical trial. J Am Med Assoc. 2018;319:27-37.
Colli A, Gallo M, Bernabeu E, et al. Aortic valve calcium scoring is a predictor of paravalvular aortic regurgitation after transcatheter aortic valve implantation. Ann Cardiothorac Surg. 2012;1:156-159.
Reiff C, Zhingre Sanchez JD, Mattison LM, et al. 3-Dimensional printing to predict paravalvular regurgitation after transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2020;96:E703-E710.
Van Belle E, Juthier F, France 2 Investigators, et al. Postprocedural aortic regurgitation in balloon-expandable and self-expandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 Registry. Circulation. 2014;129:1415-1427.
Ionescu A, Fraser AG, Butchart EG. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transesophageal echocardiography. Heart. 2003;89:1316-1321.
Rallidis LS, Moyssakis IE, Ikonomidis I, Nihoyannopoulos P. Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up. Am Heart J. 1999;138:351-357.
Ando T, Briasoulis A, Telila T, Afonso L, Grines CL, Takagi H. Does mild paravalvular regurgitation post transcatheter aortic valve implantation affect survival? A meta-analysis. Catheter Cardiovasc Interv. 2018;91:135-147.
Flynn CD, Williams ML, Chakos A, Hirst L, Muston B, Tian DH. Sutureless valve and rapid deployment valves: a systematic review and meta-analysis of comparative studies. Ann Cardiothorac Surg. 2020;9:364-374.
Di Eusanio M, Phan K, Berretta P, et al. Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR): early results from 3343 patients. Eur J Cardiothorac Surg. 2018;54:768-773.
Andreas M, Coti I, Rosenhek R, et al. Intermediate-term outcome of 500 consecutive rapid-deployment surgical aortic valve procedures. Eur J Cardiothorac Surg. 2019;55:527-533.
Di Eusanio M, Berretta P. The sutureless and rapid-deployment aortic valve replacement international registry: lessons learned from more than 4,500 patients. Ann Cardiothorac Surg. 2020;9:289-297.
Chirichilli I, Irace F, Weltert L, et al. Morphological modification of the aortic annulus in tricuspid and bicuspid valves after aortic valve reimplantation: an electrocardiography-gated computed tomography study. Eur J Cardiothorac Surg. 2019;56:778-784.