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

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Biomaterials Science

Background:

• Transcatheter aortic valve replacement (TAVR) with self-expanding supra-annular valves demonstrates superior hemodynamic performance and durability compared to surgical aortic valve replacement (SAVR).
• Investigating the feasibility of surgically implanting TAVR valves aims to combine the benefits of these advanced valves with a surgical approach.

Observation:

• A self-expanding supra-annular valve (Evolut, Medtronic) was surgically implanted in four patients undergoing SAVR using standard surgical techniques.
• Patient profiles included three with native aortic valve disease and one with a degenerated bioprosthesis.
• Valve sizes implanted were 29-mm Evolut valves, with measured native annulus sizes of 21-mm (n=3) and 23-mm (n=1).

Findings:

• Successful surgical implantation of the Evolut valve was achieved in all four patients without observed valve migration.
• Post-procedure, no patients required a pacemaker, and echocardiography revealed low mean aortic valve gradients (5.3 mm Hg).
• One patient experienced a mild paravalvular leak, indicating a generally safe and effective procedure.

Implications:

• Surgical aortic valve replacement using a transcatheter self-expanding supra-annular valve is a feasible alternative for patients ineligible for TAVR.
• This technique may offer improved hemodynamic outcomes and valve durability in specific patient populations.
• Further research is warranted to establish long-term outcomes and expand the application of this hybrid approach.