Aortic Valve Replacement with Rapid-Deployment Bioprostheses: Long-Term Single-Center Results After 1000 Consecutive...

Introduction: This study aimed to analyze long-term survival and valve-related adverse events after 1000 consecutive rapid-deployment surgical aortic valve replacements (RD-SAVRs) in a single center. Methods: A total of 1000 patients following RD-SAVR at our institution were included in a prospective database. Median follow-up was 68 months (IQR: 37-91). Preoperative and operative parameters, survival and valve-related adverse events were assessed. Results: Mean age was 73 ± 7 years (45% female). Median EuroSCORE II was 2.7% (IQR: 1.4-5.5). Concomitant procedures were performed in 50% of patients. In the case of isolated SAVR, minimally invasive access was conducted in 415 patients (83%). New early pacemaker implantation was required in 9.1%. Perioperative stroke was observed in 1.6%, and the cumulative incidence of thromboembolic and major bleeding events at 10 years was 8.1% (95% CI: 6.2-10.4%). The 5- and 10-year incidences of severe structural valve degeneration were 0.8% (95% CI: 0.3-2.1%) and 9.2% (95% CI: 4.5-15.9%). Overall re-intervention or re-operation with valve explantation occurred in 38 cases, with a 10-year incidence of 7.7% (95% CI: 5.0-11.2%). Overall 30-day mortality was 0.3% (n = 3) and survival at 1, 5 and 10 years FU was 95% (95% CI: 93-96%), 81% (95% CI: 78-84%) and 58% (95% CI: 51-64%). Age, diabetes, COPD and creatinine, concomitant procedures and acute indication were independent predictive factors of mortality. Conclusions: Rapid-deployment valves appear to support minimally invasive access and can be potentially used with low operative mortality in a real-world collective. Favorable durability with acceptable valve-related event rates and mortality were observed at long-term follow-up.