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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Sutureless aortic valve replacement: catheter-based transapical versus direct transaortic implantation
Mirko Doss1, Estelle Buhr, Anton Moritz
1Division of Cardiothoracic Surgery, Johann Wolfgang Goethe, University, Frankfurt/Main, Germany. mirko.doss@kgu.de
The Journal of Heart Valve Disease
|February 16, 2013
Summary
Transcatheter aortic valve implantation can compromise coronary perfusion. A sutureless transaortic valve replacement allows leaflet debridement, reducing risks and improving outcomes compared to transapical approaches.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Biomaterials Science
Background:
- Catheter-based aortic valve implantation leaves native calcified leaflets, potentially obstructing coronary arteries and the conduction system.
- This can limit the effective orifice area and lead to adverse perioperative events.
Purpose of the Study:
- To evaluate the perioperative outcomes of a self-expanding, sutureless aortic valve inserted via conventional aortotomy.
- To compare this approach with catheter-based transapical aortic valve implantation.
Main Methods:
- A total of 56 patients with aortic valve stenosis were included.
- 29 patients received transapical Edwards SAPIEN prosthesis; 27 received transaortic ATS 3F Enable prosthesis.
- The transaortic group underwent debridement of native leaflets using cardiopulmonary bypass (CPB).
Main Results:
- 30-day mortality was 11% in the transaortic group vs. 17% in the transapical group.
- The transaortic group had no paravalvular leaks, while the transapical group had four.
- Transapical implantation had higher rates of valve migration, heart block, and coronary obstruction.
Conclusions:
- Both sutureless aortic valve replacement devices can be safely implanted.
- The transaortic approach offers advantages, including native leaflet resection and reduced paravalvular leak rates.
- Elevated creatine kinase MB fraction was noted in the transapical group, with comparable inflammatory markers between groups.
