A New Way to Avoid the Pitfall of the Paravalvular Leakage in Patients With Rapid Deployment Valve
Taira Yamamoto, Associate Professor, Daisuke Endo, Tohru Asai, Professor, Atsushi Amano, Professor
Juntendo University, Tokyo, Japan
Objective: We started aortic valve replacement using a Rapid-deployment valve (RD-AVR) in April 2019. We will report the unexpected pitfall and the handling technique that has been seen in past cases. Methods: We had operated on 38 patients until 2020 April. Their mean age was 74.2 years. The outcomes related to the the paravalvular leakage(PVL). We performed subset analyses on the relationship between the new technical methods and outcomes.Results: The mean operation time was 196 minutes. There were no hospital deaths, Valve size is 19mm (4 cases), 21mm (8 cases), 23mm (16 cases), 25mm (10 cases), female (4 cases, 6 cases, 0, 0). Aortic bicuspid valve (0, 0, 19%, 50%) UCG preoperative measurement: Annulus (mm) (18.7, 20.8, 21.2, 23.6). Comparing the size of the artificial replacement valve and the preoperative predicted size, it was almost the same at 19 and 21 mm but predicted and dissociated at 23 and 25 mm. However, PVL (mild or more) was 4cases (0, 0, 2, 2) in one-year follow-up. We performed the additional extra stitch for the gap, which is recognized below the right-noncoronary commissure in the last 18 cases. We have no PVL in the last 18 patients and no new pacemaker implantation.Discussion: In the case where the aortic annulus is enlarged, especially in the bicuspid valve, we found that Gap occurs between the artificial valve and Nadir because the commissural part
is high and spreads outward. Since the artificial valve's height does not reach the commissure, we think that we should suture an extra needle to the everted mattress at this site.Conclusion: We concluded the PVL was more likely to occur due to the gap below the R-N commissure, especially in cases with large annulus sizes. In such cases, an additional stitch to R-N commissure is extremely useful.