Titanium Fasteners During Aortic Valve Replacements: Assessment Of Safety And Efficacy
Joshua K. Wong, Vishnu Kadiyala, Allison Forrest, Hannah DeSelms, Devang J. Joshi, Amber L. Melvin, Juan Siordia, George L. Hicks, Sunil M. Prasad, Peter A. Knight.
University of Rochester Medical Center, Rochester, NY, USA.
OBJECTIVE: The use of titanium fasteners (TF) in lieu of hand-tied knots during aortic valve replacement (AVR) surgery is increasing worldwide. Despite this, limited data is available on the outcomes of patients who have their prosthetic aortic valves secured using this technology.
METHODS: A review of AVR’s (N=1035) performed at an academic medical center from January 2008 to October 2014 was performed to allow a minimum 2-year follow-up in all patients. Cases where TF’s were used to secure the prosthetic valve were identified (TF-group, n=153) and their outcomes compared to a control where conventional hand-tied knots were used (HT-group, n=882). Outcome variables considered relevant to the use of TF’s included cardiopulmonary bypass (CPB) and cross-clamp times, cerebrovascular accidents (CVA), renal failure, acute limb ischemia (ALI), peri-valvular leaks (PVL), and ≥2+ aortic insufficiency (AI). A sub-analysis in patients undergoing isolated AVR’s was also performed
RESULTS: There were no significant differences noted between TF and HT groups on the incidence of redo-sternotomies (14% vs. 15%, p=0.71), concomitant procedures (42% vs. 49%, p=0.19), endocarditis (4% vs. 5%, p=0.69), and other relevant co-morbidities. However, TF use was associated with a significant reduction in mean CPB (110 vs. 126 minutes, p=0.01) and cross-clamp times (87 vs. 96 minutes, p=0.01), when compared to control. Additionally, no differences were noted between groups on post-operative CVA’s, renal failure, ALI, and in-hospital mortality (p>0.05). In the sub-set of isolated AVR’s, CPB (88 vs. 103 minutes, p<0.01) and cross-clamp (67 vs. 76 minutes, p<0.01) times also remained shorter in TF patients. During follow-up, ≥2+ AI was present in 1% of TF-patients vs. 2% in the HT-group (p=0.51), while a significantly lower incidence of detected PVL’s were noted in the TF vs. HT group, most notably in patients undergoing isolated AVR’s (1% vs. 7%, p=0.05).
CONCLUSIONS: In the largest reported cohort of patients undergoing AVR with TF to date, this study provides evidence that the use of TF’s do not lead to increased complications but instead could lead to a reduction in critical operative times and PVL rates.
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