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Mini-thoracotomy for Sutureless-Rapid-Deployment Aortic Valve Replacement: Initial single center experience
GŁnther Laufer, Dominik Wiedemann, Amit Vadehra, Raphael Rosenhek, Thomas Binder, Alfred Kocher.
Medical University of Vienna, Vienna, Austria.

OBJECTIVE: A new class of rapid deployment aortic valves has emerged with the potential to simplify minimally invasive aortic surgery and reduce cross-clamp and cardiopulmonary bypass times. We report the first experience of aortic valve replacement with the EDWARDS INTUITY Valve System Generation 2 via a right thoracotomy.
METHODS: Between May 2011 and July 2012 13 patients (age 79 (44-92); 50% female) with aortic stenosis requiring valve replacement were treated at our center by a single surgeon. A stented tri-leaflet bovine pericardial bioprosthesis with a balloon expandable cloth-covered stent frame at the inflow aspect was implanted through a right thoracotomy with a 7 cm skin incision. The aorta was directly cannulated whereas the venous cannula was inserted percutanuously via the femoral vein. Four valve sizes were implanted 21 to 27 mm. Patients were followed at discharge, 3 months, and 1 year postoperatively.
RESULTS: 1 patient had to be excluded due to a true bicuspid valve with 2 commissures and no raphe. Implantation success was 100% in the remaining 12 patients; no early valve-related mortality was observed. Cardiopulomonary bypass time and aortic cross clamp time were 121 ±6 min and 86 ±5 min respectively. Mean pressure gradient and peak pressure were 13.4 ±1.8 mmHg and 22.4 ±2.1 mmHg at discharge, and 9.4 ±1.0 mmHg and 18.5 ±2.0 at 3 months, respectively.
CONCLUSIONS: In this first, single center experience implantation of the EDWARDS INTUITY Valve System through a mini-thoracotomy has been shown to be feasible, safe, and effective for aortic valve replacement. The fast and simple implantation technique facilitates a short operation time. Early hemodynamic performance was excellent.


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