Rapid-deployment Valve Is An Excellent Tool For Patients With Small Aortic Roots In Minimally Invasive Surgery
Mislav Planinc, Iuliana Coti, Alfred Kocher, Martin Andreas, Stephane Mahr, Shiva Shabanian, Thomas Haberl, Thomas Aschacher, Marek Ehrlich, Dominik Wiedemann, Gunther Laufer.
Medical University of Vienna, Vienna, Austria.
Surgical management of patients with a small aortic root planned for aortic valve replacement (AVR) remains challenging. The mortality of patients undergoing isolated AVR and aortic root enlargement is still around 6% according to the most recent STS dataset. The goal of the present study was to examine the impact of the rapid-deployment Edwards Intuity valve (RDV) on mortality in this patient cohort operated on through a minimally invasive approach (MIS).
All patients who underwent AVR with RDV in our institution between May 2010 and November 2016 were enrolled and retrospectively analyzed with regard to postoperative transvalvular gradients and mortality.
A total of 422 patients received an RDV at our institution. Out of this cohort 145 (34%) patients had a small aortic root as defined by implant sizes 19 mm and 21 mm. A total of 125 (86%) patients underwent isolated AVR with 44% (n=55) through MIS. Upper hemisternotomy was the preferred approach in 19 patients (34%) and 36 (66%) were operated by anterior right thoracotomy. Postoperative gradients in RDV 19 mm and 21 mm were 12 ± 4 mmHg and 14 ± 6 mmHg, respectively. Notably, not one single patient scheduled for MIS had to be excluded and we had no conversion to root enlargement within the 6 year study period.
In patients with small aortic root hospital mortality was 0.7% (n=1) and in follow-up (up to 5 years) late mortality was 7% (n=10).
Implantation of RDV is a highly reproducible technique. It facilitates minimally invasive surgery even in patients with small aortic roots with excellent results.
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