The use of rapid deployment valves in combined Aortic and Mitral valve surgery - 1 year clinical and echocardiographic outcomes
Markus Schloemicher, Peter Lukas Haldenwang, Vadim Moustafine, Matthias Bechtel, Justus Thomas Strauch.
Ruhr-University Hospital Bergmannsheil, Bochum, Germany.
OBJECTIVE: Patients undergoing multiple valve surgery represent a high risk group who could potentially benefit from a reduction of cross clamp and cardiopulmonary bypass times since prolonged bypass and crossclamp times are considered independent risk factors for increased morbidity and mortality following cardiac surgery
METHODS: Between July 2013 and November 2014 16 patients underwent rapid deployment AVR with the Edwards Intuity Valve System in the setting of concomitant mitral disease.
15 patients showed mitral regurgitation whereas on patient had severe mitral stenosis. 14 patients received Mitral valve repair and 2 patients biological mitral valve replacement. Tricuspid Vlve repair was performed additionally in 2 patients. The mean age was 72,8 ± 8,4 years and the mean logistic Euroscore II 8,7 ± 3,4 %.
RESULTS: Within a 30 day perioperative period no patient was lost. (n=0) The mean follow up time was 11 ± 2 months. At 1 year the overall survival was 81% (n=13). A mean transaortic gradient of 10,7 ± 2,3 mmHg and a mean effective orifice area of 1,7 ± 0,3 cm2 were measured echocardiographically. No higher grade paravalvular leak (AI > 1+) occurred. 8 Patients (61%) had no residual mitral regurgitation, 4 patients (30%) showed trivial regurgitation (1/4) and one patient (7,3%) had moderate mitral regurgitation (2/4). No Interference of the subannular stentframe with the reconstructed valve or the biological mitral prosthesis was seen.
CONCLUSIONS: Rapid deployment AVR with the Edwards Intuity Valve System in combined Aortic and Mitral valve surgery can be performed safely with reproducible results. One year follow up data of this small series shows encouraging results potentially justifying the extension of the indication for rapid deployment valves to patients with concomitant mitral disease. Especially elderly patients undergoing multiple valve surgery may benefit from a reduction of cardiopulmonary bypass und myocardial ischemic times
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