Back to 2024 Display ePosters
Minimally Invasive Aortic Valve Replacement With A Sutureless Valve In Elderly
Marie Lamberigts, Delphine Szecel, Filip Rega, Peter Verbrugghe, Christophe Dubois, Bart Meuris;
Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
BACKGROUND: With transcatheter AVR becoming the preferred treatment in guidelines, we investigated the outcome of minimally invasive aortic valve replacement using sutureless valves in an elderly population.
METHODS: This is a retrospective, monocentric study of all patients treated with a sutureless valve between January 2007 and June 2022. All patients had to be treated via a minimally invasive technique (mini-sternotomy or right anterior thoracotomy (RATS)). Results are presented as n (%) or as median (interquartile range). During this period, both the implant sizing technique and the valve type evolved.
RESULTS: In total, 394 patients received a sutureless valve via MICS. The median age of this population was 80 years (75 - 83) with 51% octogenarians. The median EuroSCORE II was 2.5% (1.7 - 3.7). Nearly all patients were treated for a single aortic valve replacement (97.7%). Mini-sternotomy was used in 359 patients (91.1%), RATS in 25 patients (6.3%), 10 patients (2.6%) were converted from a MICS approach to full sternotomy. Procedure times were short with a median cardiopulmonary bypass time and cross-clamp time of 61 (51 - 72) min. and 38 (32 - 45) min. respectively. Postoperative complication rates were low: in-hospital mortality was 2 (0.5%), stroke was 8 (2.0%), 11 (2.8%) patients needing reoperation for bleeding and new need for dialysis in 3 (0.8%) patients.The evolution in valve sizing and shift towards the updated valve resulted in a pacemaker rate which decreased from 8.4% in the initial period to 5.3%. Hemodynamic performance improved with peak gradients decreasing from 25 (20 - 32) mmHg to 19 (15 -25) mmHg and mean gradients decreasing from 14 (22 - 17) mmHg to 11 (9 - 14) mmHg for the old and new valve version respectively. Paravalvular leaks (>1/4) were rare with only 0.5% as overall incidence.
CONCLUSIONS: With a population of which the majority is octogenarian, we still observe very low rates of major postoperative complications with in-hospital mortality and stroke rates in combination with good hemodynamics after sutureless minimally invasive aortic valve replacement. Both pacemaker rates and paravalvular leakage are lower than reported in TAVI trails in this patient population.
Back to 2024 Display ePosters
