Surgical Aortic Valve Replacement Using a Supra-Annular Self-Expanding Bioprosthesis

The transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve has shown better hemodynamic outcomes and better valve durability at 5 years when compared with a surgical aortic valve replacement (SAVR). It is possible that the benefits of a self-expanding supra-annular valve can be achieved using a surgical approach. An Evolut (Medtronic) transcatheter aortic valve was surgically implanted in 4 patients undergoing SAVR. Standard surgical methods were used. Three patients had native aortic valve disease, and 1 patient had a degenerated surgical bioprosthesis. The measured valve size was 21 mm in 3 patients and 23 mm in 1 patient; all received a 29-mm Evolut. No valve migration was observed. No patients required a pacemaker. Discharge echocardiography showed low aortic valve gradients (arithmetic mean of 5.3 mm Hg). One patient had a mild paravalvular leak. SAVR using a self-expanding supra-annular valve can be successfully performed in patients not amenable to TAVR.