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Rapid-Deployment Versus Conventional Bio-Prosthetic Aortic Valve Replacement.

Andrew L Smith1, William Y Shi1, Alexander Rosalion2

  • 1Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Vic, Australia; School of Medicine, University of Melbourne, Melbourne, Vic, Australia.

Heart, Lung & Circulation
|August 16, 2016
PubMed
Summary

Rapid-deployment aortic valve replacement (RD-AVR) significantly reduces cross-clamp and bypass times compared to conventional AVR (cAVR). RD-AVR is associated with decreased perioperative morbidity in selected patients.

Keywords:
Aortic stenosisAortic valveCardiac surgical proceduresCardiopulmonary bypass.Rapid deployment aortic valve replacementThoracic surgery

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Area of Science:

  • Cardiovascular Surgery
  • Medical Devices
  • Thoracic Surgery

Background:

  • Rapid-deployment aortic valve replacement (RD-AVR) use is increasing.
  • Limited comparative studies exist for RD-AVR versus conventional aortic valve replacement (cAVR).
  • No prior studies compared both methods via full sternotomy.

Purpose of the Study:

  • To compare perioperative outcomes of RD-AVR and cAVR in patients undergoing isolated aortic valve replacement.
  • To evaluate the efficacy and safety of RD-AVR when inserted via full sternotomy.

Main Methods:

  • Retrospective review of 597 patients undergoing isolated aortic valve replacement ± CABG (2008-2015).
  • 41 patients received RD-AVR (via full sternotomy in 98%) and 556 received cAVR.
  • Propensity score matching created 41 matched pairs for outcome comparison.

Main Results:

  • RD-AVR group had significantly shorter aortic cross-clamp (71 vs. 106 min) and cardiopulmonary bypass times (95 vs. 134 min).
  • No significant difference in 30-day mortality (2% vs. 2%).
  • RD-AVR associated with shorter ventilation (17 vs. 63 hrs), ICU stay (51 vs. 108 hrs), and reduced postoperative atrial arrhythmias (8% vs. 20%).

Conclusions:

  • RD-AVR shortens operative times and reduces perioperative morbidity.
  • RD-AVR is a valuable option for selected patients undergoing aortic valve replacement.
  • Further long-term follow-up is needed to ascertain the full potential of RD-AVR devices.