Early Experience With A Novel Pericardial Aortic Prosthesis Designed To Facilitate Future Valve-in-valve Treatment
Oliver D. Bhadra, Andreas Schäfer, Jonas Pausch, Hermann Reichenspurner, Lenard Conradi.
University Heart and Vascular Center Hamburg, Hamburg, Germany.
BACKGROUND: The expanded use of bioprosthetic aortic valve replacement (AVR) results in a decreasing mean age of patients at the time of implantation. Therefore, surgeons will increasingly be confronted with deteriorated valves requiring subsequent treatment strategies including valve-in-valve (ViV) therapy. The novel Edwards Inspiris bovine pericardial valve (Edwards Lifesciences, Irvine, CA, USA) offers a stent frame expansion zone intended to facilitate possible future ViV. This can lead to a larger EOA due to the implantation of a larger transcatheter valve resulting in better hemodynamic performance. This single centre report evaluates early clinical outcomes and hemodynamic performance of this novel bioprosthesis. METHODS: From October 2017 - June 2021, 81 patients (age 50±9.5 years, 62% male, logEuroSCORE II 1.6±1.5%, STS Score 0.93±0.53%) underwent elective AVR. Isolated AVR were performed via partial upper sternotomy. Acute clinical and hemodynamic results are presented. RESULTS: Indications for AVR were severe aortic regurgitation, severe aortic stenosis and mixed lesions in 48% (39/81), 27% (22/81) and 25% (20/81). 60% (49/81) of the patients had a bicuspid aortic valve. Isolated AVR was performed in 56% (45/81), combined procedures in 44% (36/81) including replacement of the ascending aorta 26% (21/81), CABG 16% (13/81), mitral valve repair/replacement 9% (7/81), Bentall procedure 7% (6/81), tricuspid valve replacement 1% (1/81). 27% (22/81) of patients underwent redo surgery. Valve sizes used were 21/23/25/27/29mm in 2%/17%/36%/38%/7% of cases. Mean procedure / cardiopulmonary bypass / aortic cross-clamp times for isolated vs. combined procedures were 214±85 / 116±46 / 80±29 and 268±103 / 159±70 / 101±45 minutes. Duration of intensive care and overall hospital stay were 2.7±3.1 and 8.3±2.6 days. Echocardiography at discharge demonstrated peak/mean transvalvular gradients of 18.9±6.9/10.3±4.8 mmHg and no paravalvular leakage >mild in any patient. In-hospital and 30-day mortality were 0%. There was a significant difference in permanent pacemaker implantation rate between first and redo surgery cohorts (3% vs. 18%, p=0.04, overall: 7% (6/81)). CONCLUSIONS:Early experience with this novel type of pericardial valve was favourable in a mixed patient population resulting in early mortality of 0% despite a high rate of redo-surgery (27%). Durability as well as feasibility and hemodynamic advantages of ViV procedure in this new modified surgical valve must be proven in the future.
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