Rapid Deployment Versus Conventional Bioprosthetic Valve Replacement for Aortic Stenosis

Area of Science:

• Cardiovascular Surgery
• Medical Device Technology
• Clinical Outcomes Research

Background:

• Conventional biological valves (CBVs) are standard for surgical aortic valve replacement in elderly patients.
• Rapid deployment valves (RDVs) represent a newer alternative for aortic valve disease treatment.

Purpose of the Study:

• To report nationwide German experience with RDVs for aortic valve stenosis.
• To compare the outcomes of RDVs head-to-head with CBVs.

Main Methods:

• Analysis of 22,062 patients from the German Aortic Valve Registry (2011-2015).
• Isolated surgical aortic valve replacement using CBVs or RDVs.
• 1:1 propensity score matching to compare baseline, procedural, and in-hospital outcomes.

Main Results:

• RDVs were associated with significantly reduced procedure, cardiopulmonary bypass, and aortic cross-clamp times.
• RDV use led to significantly higher rates of pacemaker implantation (8.8% vs 3.7%) and disabling stroke (2.2% vs 0.9%).
• In-hospital mortality was similar between RDVs and CBVs (2.2% vs 1.7%), persisting after propensity score matching.

Conclusions:

• RDVs in aortic valve replacement are linked to increased pacemaker implantation and disabling stroke rates without improving in-hospital mortality.
• The three compared RDVs exhibited distinct complication profiles regarding pacemaker rates and transvalvular gradients.