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Published on: March 26, 2018
International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally
Mattia Glauber1, Simon C Moten, Eugenio Quaini
1From the *Istituto Clinico Sant' Ambrogio, Clinical & Research Hospital IRCCS-Gruppo Ospedaliero San Donato, Milano, Italy; †Austin Health and Royal Melbourne Hospital, Melbourne, Australia; ‡Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy; §Centre Hospitalo-Universitaire Brabois ILCV, Nancy, France; ∥U.Z. Gasthuisberg, Leuven, Belgium; ¶Unniversitat Kilinik, Graz, Austria; #Ospedale di Mantova, Mantua, Italy; **Southlake Regional Health Centre, McMaster University, Hamilton, Canada; ††Trillium Cardiovascular Associates, Mississauga, Ontario, Canada; ‡‡Columbia University Medical Center, New York, NY USA; §§University of Montreal, Montreal, Quebec, Canada; ∥∥CHU le Bocage, Dijon, France; ¶¶Freeman Hospital, Newcastle, United Kingdom; ##Klinikum Oldenburg, Oldenburg, Germany; ***Klinikum Nuernberg, Nuremberg, Germany; †††Medizinische Universitaet Innsbruck, Austria; ‡‡‡Ospedale Ferrarotto, Catania, Italy; §§§Blackpool Victoria Hospital, Blackpool, United Kingdom; ∥∥∥Cliniques Universitaires St-Luc, Brussels, Belgium; ¶¶¶Hospital University Germans Trias I Pujol, Barcelona, Spain; ###Medizinischen Hochschule Hannover, Hannover, Germany; ****Mayo Clinic, Rochester, MN USA; ††††Fondazione Poliambulanza, Brescia, Italy; and ‡‡‡‡University Medical Center Ljubljana, Ljubljana, Slovenia.
Objective:
To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement.
Methods:
A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach.
Results:
No guideline could be retrieved. Thirty-three clinical trials and 9 systematic reviews could be identified for detailed text analysis to obtain a total of 24 recommendations. After rating by the experts 12, final recommendations were identified: preoperative computed tomographic scan as well as intraoperative transesophageal echocardiography are highly recommended. Suitable annular sizes are 19 to 27 mm. There is a contraindication for bicuspid valves only for type 0 and for annular abscess or destruction due to infective endocarditis. The use of sutureless and rapid deployment valves reduces extracorporeal circulation and aortic cross-clamp time and leads to less early complications as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions, paravalvular leakages and aortic regurgitation, and renal replacement therapy, respectively. These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs. The use of sutureless and rapid deployment valves will lead to a higher adoption rate of minimally invasive approaches in aortic valve replacement. Respect should be taken to a necessary short learning curve for both sutureless and minimally invasive programs.
Conclusions:
Sutureless and rapid deployment aortic valve replacement together with minimally invasive approaches offers an attractive option in aortic valve placement for patients requiring biological valve replacement.
