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Isolated aortic valve replacement with upper hemi-sternotomy using balloon expandable sutureless valve; evaluation of results during our learning curve.
Francesco Pirone, Ricardo Boix-Garibo, Michael Sabetai, James Roxburgh, Vinayak Bapat, Christopher P. Young.
St Thomas Hospital, London, United Kingdom.
OBJECTIVE: Balloon expandable sutureless valve (BEV) can facilitate minimally invasive approach for isolated aortic valve replacement (AVR) and may play an important role in reducing morbidity and improve patient recovery and satisfaction. We reviewed our experience with balloon expandable sutureless valve (BEV) for isolated AVR
METHODS: From July 2012 to October 2014, 44 patients underwent AVR with BEV. Of these 27 patients underwent isolated AVR with upper hemi-sternotomy (UHS). Intraoperative and post-operative echocardiogram performed in all patients. Data were retrospectively analysed form our prospectively maintained database. Continuous variable were expressed as mean ± standard deviation and categorical one in incidence rate and ratio (SPSS 20.0)
RESULTS: Patient’s demographics and risk profile are summarised in table 1. UHS at the 4th intercostal space was utilised in 100% patients with no conversion to full sternotomy. One third had poor to moderate LV function. Mean bypass time and crossclamp time were respectively 58 ± 13 and 43 ± 11 minutes. Post-operative paravalvular grades 1/2/>2 in 25/7/0% of patients. 30-days mortality was 0%. Mean post operative bleeding was 350 mls but 4 patients required re-exploration (14%). One patient was reoperated four month following implantation for haemolysis due to paravalvular leak. The valve was replaced with a sutured aortic valve. Another patient was diagnosed with significant paraprosthetic leak due to endocarditis 18 months after surgery treated successfully with iv antibiotics.
CONCLUSIONS: Use of BEV is a safe alternative to conventional aortic valve replacement with sutured valve and it can be performed with a minimally invasive approach and with short crossclamp and bypass time.
| Male | 22 (67%) |
| Logistic Euroscore | 6.7 ± 3 % |
| BMI | 29.4 ± 7 |
| Poor-Moderate EF | 9 (33%) |
| COPD | 3 (11%) |
| Corssclamp time | 43 ± 11 min |
| Cardiopulmonary bypass time | 58 ± 13 min |
| Bleeding | 350 ± 384 mls |
| ITU Stay | 1.2 ± 0.5 days |
| Valve related reoperation | 1 (3.7%) |
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