International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

Abstract OBJECTIVES: The impact of sutureless and rapid deployment (SURD) valves on the clinical outcomes of patients undergoing minimally invasive aortic valve replacement (MI-AVR) has still to be defined. The aim of this study was to assess clinical characteristics and in-hospital results of patients receiving SURD-AVR through less invasive approaches in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS: Of the 1935 patients who received primary isolated SURD-AVR between 2009 and 2018, a total of 1418 (73.3%) underwent MI interventions and were included in this analysis. SURD-AVR was performed using upper ministernotomy in 56.4% (n = 800) of cases and anterior right thoracotomy in 43.6% (n = 618). Perceval S was implanted in 1011 (71.3%) patients and Edwards Intuity or Intuity Elite in 407 (28.7%) patients. RESULTS: Overall in-hospital mortality and stroke rates were 1.7% and 2%, respectively. A definitive pacemaker implantation was reported in 9% of cases and significantly decreased over the observational period, from 20.6% to 5.6% (P = 0.002). The Perceval valve was associated with shorter operative times and was more frequently implanted in patients receiving anterior right thoracotomy incision. The Intuity valve was preferred in younger patients and revealed superior postoperative haemodynamic results. CONCLUSIONS: SURD-AVR was largely performed through less invasive approaches and can be considered as a primary indication in MI surgery. In the SURD-IR cohort, MI SURD-AVR using both Perceval and Intuity valves appeared a safe and reproducible procedure associated with promising early results.

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Minimally Invasive Implantation of the EDWARDS INTUITY Rapid Deployment Aortic Valve via a Right Minithoracotomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000158 ◽

2015 ◽

Vol 10 (3) ◽

pp. 215-217 ◽

Cited By ~ 2

Author(s):

Aristidis Lenos ◽

Anno Diegeler

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Pacemaker Implantation ◽

Paravalvular Leak ◽

Hemodynamic Performance ◽

Invasive Techniques ◽

Rapid Deployment

During the past decade, many surgeons have focused their interest on the development and improvement of minimally invasive techniques for aortic valve replacement. Although the minimally invasive approaches for the treatment of mitral valve disease have been standardized, the preferred route for aortic valve replacement remains a matter of debate. Access through a right minithoracotomy avoids opening the sternum; however, it requires a greater surgical ability and a learning period, even for experienced surgeons. This enhances the role of sutureless prostheses because these devices are associated with easier placement, excellent hemodynamic performance, and acceptable rates of pacemaker implantation and paravalvular leak. Herein, we report a series of 10 consecutive patients who received an EDWARDS INTUITY rapid deployment valve (Edwards Lifesciences, Irvine, CA USA) by a right minithoracotomy.

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Faculty Opinions recommendation of A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725256611.793523902 ◽

2016 ◽

Author(s):

Nawwar Al-Attar

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Multicenter Trial ◽

Rapid Deployment

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A Randomized Multicenter Trial of Minimally Invasive Rapid Deployment Versus Conventional Full Sternotomy Aortic Valve Replacement

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.09.022 ◽

2015 ◽

Vol 99 (1) ◽

pp. 17-25 ◽

Cited By ~ 108

Author(s):

Michael A. Borger ◽

Vadim Moustafine ◽

Lenard Conradi ◽

Christoph Knosalla ◽

Markus Richter ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Multicenter Trial ◽

Rapid Deployment

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Minimally invasive sutureless and rapid deployment aortic valve replacement: the new benchmark for aortic valve surgery?

Annals of Cardiothoracic Surgery ◽

10.21037/acs-2019-surd-175 ◽

2020 ◽

Vol 9 (4) ◽

pp. 328-329

Author(s):

Francesco Pollari ◽

Theodor Fischlein

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Rapid Deployment

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International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000287 ◽

2016 ◽

Vol 11 (3) ◽

pp. 165-173 ◽

Cited By ~ 18

Author(s):

Mattia Glauber ◽

Simon C. Moten ◽

Eugenio Quaini ◽

Marco Solinas ◽

Thierry A. Folliguet ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Aortic Cross Clamp Time ◽

Modified Delphi ◽

Delphi Approach ◽

Attractive Option ◽

Rapid Deployment ◽

International Experts

Objective To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement. Methods A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach. Results No guideline could be retrieved. Thirty-three clinical trials and 9 systematic reviews could be identified for detailed text analysis to obtain a total of 24 recommendations. After rating by the experts 12, final recommendations were identified: preoperative computed to-mographic scan as well as intraoperative transesophageal echocardiography are highly recommended. Suitable annular sizes are 19 to 27 mm. There is a contraindication for bicuspid valves only for type 0 and for annular abscess or destruction due to infective endocarditis. The use of sutureless and rapid deployment valves reduces extracorporeal circulation and aortic cross-clamp time and leads to less early complications as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions, paravalvular leakages and aortic regurgitation, and renal replacement therapy, respectively. These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs. The use of sutureless and rapid deployment valves will lead to a higher adoption rate of minimally invasive approaches in aortic valve replacement. Respect should be taken to a necessary short learning curve for both sutureless and minimally invasive programs. Conclusions Sutureless and rapid deployment aortic valve replacement together with minimally invasive approaches offers an attractive option in aortic valve placement for patients requiring biological valve replacement.

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