Early Outcomes with Rapid-deployment vs Stented Biological Valves: A Propensity-match Analysis

Rapid-deployment valves could potentially reduce cross-clamping time and cardiopulmonary bypass time in complex combined procedures and facilitate minimally invasive surgery. This propensity-matched study compared clinical and echographic outcomes between patients undergoing rapid-deployment aortic valve replacement (RDAVR) compared with stented biological aortic valve replacement (SAVR), with or without concomitant procedures. Between 2012 and 2015, 61 consecutive patients (age 70 ± 7 years, European System for Cardiac Operative Risk Evaluation [EuroSCORE] II 2.1%) underwent aortic valve replacement with Intuity prosthesis (Edwards, Irvine, CA) at the Montreal Heart Institute. This group was compared to 1496 consecutive patients (age 74 ± 8 years, logistic EuroSCORE II 2.8%) who underwent SAVR in the same period. After propensity score matching (1:3), 59 patients in the RDAVR group were matched to 177 patients in the SAVR group. Preoperative characteristics and risk scores were similar in matched groups. Cardiopulmonary bypass, cross-clamp, and total surgical times were lower in the RDAVR group compared with the SAVR group (P < 0.001). Within 30 days, 1 patient died in the SAVR group and none died in the RDAVR group (P = 0.31). The need for pacemaker implantation was higher in the RDAVR group, although the difference was not significant (12% vs 5%, P = 0.13). RDAVR patients less frequently required transfusions (P = 0.025) and had a shorter intubation time (P = 0.002). RDAVR facilitates minimally invasive aortic valve replacement and is associated with shorter bypass and cross-clamp times. Moreover, RDAVR compares favorably with SAVR in terms of mortality and outcome variables.