Early outcomes after isolated aortic valve replacement with rapid deployment aortic valve

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Aortic Valve Replacement

Background:

• Minimal access aortic valve replacement (MAAVR) offers clinical benefits but is often associated with longer crossclamp times compared to full sternotomy.
• Addressing prolonged crossclamp times is crucial for wider adoption of MAAVR.

Purpose of the Study:

• To evaluate procedural and early safety outcomes of isolated rapid deployment aortic valve replacement (RD-AVR) based on surgical approach.
• To compare crossclamp and cardiopulmonary bypass times across different surgical techniques for RD-AVR.

Main Methods:

• Prospective, multicenter, single-arm study involving 287 patients with aortic valve stenosis undergoing RD-AVR.
• Patients were categorized by surgical approach: full sternotomy, upper hemisternotomy, or right anterior thoracotomy.
• Perioperative data included procedural times, technical success, length of stay, and 30-day adverse events.

Main Results:

• 158 patients underwent isolated AVR via full sternotomy (n=71), upper hemisternotomy (n=77), or right anterior thoracotomy (n=10).
• Mean aortic crossclamp and cardiopulmonary bypass times were similar for full sternotomy and upper hemisternotomy.
• Right anterior thoracotomy resulted in significantly longer crossclamp and bypass times (P < .000).

Conclusions:

• Isolated rapid deployment aortic valve replacement via upper hemisternotomy may achieve shorter crossclamp times than previously reported.
• This approach could facilitate MAAVR by mitigating concerns over prolonged crossclamp durations.
• Low in-hospital mortality and permanent pacemaker implant rates were observed across all surgical approaches.