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Aortic Valve Replacement with Suturless or Rapid Deployment Valves through Minimal or Convetional Access: Propensity Score Analysis of Early Outcomes
Marco Diena1, Philippe Caimmi2, Gheorghe Cerin3, Attilio Cotroneo2, Gabriele Musica2, Angelo Romano4, Gian Luca Martinelli2.
1Dept. of Cardiac Surgery, San Gaudenzio Clinic, Cardioteam Foundation, Novara, Italy, 2Dept. of Cardiac Surgery, San Gaudenzio Clinic, Novara, Italy, 3Dept. of Cardiology, San Gaudenzio Clinic, Novara, Italy, 4Dept. of Cardiac Anaesthesia, San Gaudenzio Clinic, Novara, Italy.
OBJECTIVE: Minimally invasive aortic valve replacement (AVR) is a safe and effective treatment option but it had not a widespread adoption until suturless or rapid deployment valves (S/RDV) are recently available. We report here our experience with the Perceval sutureless valve(Sorin, Italy) and the Intuity rapid deployment valve (Edward Lifesciences, USA) either in minimal either in conventional access.
METHODS: Between november 2013 and november 2015, data from 112 consecutive patients with aortic stenosis undergoing isolated AVR with S/RDV (Perceval group: PG, Intuity group: IG) by mean of j-ministernotomy (ministernotomy group: MSG) or full sternotomy (full sternotomy group: FSG) were prospectively recorded. Propensity score matching was performed on 15 preoperative risk factors to correct selection bias.
RESULTS: Clinical outcomes were not significantly affected by the surgical approaches or prosthesis except transfusions were significantly lower in MSG than in FSG( p < 0.034). The improvement of sizing between annulus (by echo) and S/RDV was significantly higher in PG than IG (+ 3.75±1.65 vs 1.88±1.64 mm p < 0.012). After AVR the decreasing of maximal and mean gradient were similar in both prostethic group (PG -69.13±25.68 versus IG -60±24.51 mmHg p<0.21; PG - 40.89±17.22 versus IG -43.12± 14.023mmHg p< 0.34).
CONCLUSIONS: As previously reported for stented bioprosthesis, MSG shows a significant advantage for blood consumption also in AVR with S/RDV . PG presents a greater mean sizing than IG despite similar haemodinamic performances but this observation needs more detailed imaging investigations to be confirmed.
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