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OBJECTIVE: High-risk patients affected by severe aortic stenosis represent an increasing population. Aortic valve bypass may be considered as an additional option for treatment. We report on mid-term results of a novel device incorporating a bioprosthetic stentless valve and designed to perfom off-pump aortic valve bypass.
METHODS: From March 2012 to August 2013,15 patient were submitted to aortic-valve bypass(AVB)to treat a severe aortic valve stenosis using a composite conduit incorporating a bioprosthetic valve deployed by an automated system. Patients mean age was 77±7,2 years (33% males).Mean ejection fraction(EF) was 52±13%.Mean preoperative NYHA class was 2.6±0.89.The mean LogEUROscore was 16.45±13.6%;Mean STS risk of morbidity/mortality was 26.6±16.5%.All the patients received AVB through a mid-lateral thoracotomy..In two patients a LIMA-to-LAD anastomosis was performed off-pump.In one of these two a lung tumor resection was added along with a lymphadenectomy.In two patients lung function was supported by CPB.
RESULTS: No intraoperative deaths occurred. Median ICU stay and intubation time were 42(25-75° perc:22-59.5)and 17(25-75° perc:16-19.7) hours respectively.The mean hospital stay duration was 10±6,8 days.No cerebrovascular events occurred.There were four in-hospital deaths due to MOF (2),myocardial ischemia (1) acute gastrointestinal bleeding (1). Two patients died during follow-up; one for silent hepatocarcinoma (2 months) and one for necrotic pancreatitis(6 months). Nine patients(median follow-up:14.7months;9.58-18.31) are alive; 8 patients are in NYHA class 1; one patient switched from NYHA 4 to 3. The longest survival is 21.6 months. Actuarial survival and event-free survival including inhospital mortality is 59.25% at a median followup of 11.2 months (25-75perc 1.76-17.21); actuarial survival and event-free survival out of inhospital mortality is 80.8% at a median follow-up of 14.7 months; (25-75perc:9.58-18.31).
CONCLUSIONS: AVB with automated ventricular coring system is an alternative to conventional aortic valve replacement in high risk patients. It stays besides Transcatheter Aortic Valve Implantation(TAVI) procedures or as alternative in case TAVI is not possible for technical or clinical reasons.To the best of our knowledge this is the largest single Center experience to now using this novel device.