Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

Sutureless and rapid-deployment bioprostheses have been introduced as alternatives to traditional prosthetic valves to reduce cardiopulmonary and aortic cross-clamp times during aortic valve replacement. These devices have also been employed in extremely demanding surgical settings, as underlined in the present review. Searches on the PubMed and Medline databases aimed to identify, from the English-language literature, the reported cases where both sutureless and rapid-deployment prostheses were employed in challenging surgical situations, usually complex reoperations sometimes even performed as bailout procedures. We have identified 25 patients for whom a sutureless or rapid-deployment prosthesis was used in complex redo procedures: 17 patients with a failing stentless bioprosthesis, 6 patients with a failing homograft, and 2 patients with the failure of a valve-sparing procedure. All patients survived reoperation and were reported to be alive 3 months to 4 years postoperatively. Sutureless and rapid-deployment bioprostheses have proved effective in replacing degenerated stentless bioprostheses and homografts in challenging redo procedures. In these settings, they should be considered as a valid alternative not only to traditional prostheses but also in selected cases to transcatheter valve-in-valve solutions.

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USE OF SUTURELESS AND RAPID DEPLOYMENT PROSTHESES IN CHALLENGING REOPERATIONS Review of the current evidence

10.22541/au.160656305.53247747/v1 ◽

2020 ◽

Author(s):

Igor Vendramin ◽

Daniela Piani ◽

Matteo Meneguzzi ◽

Giovanni Benedetti ◽

Daniele Muser ◽

...

Keyword(s):

Aortic Valve ◽

English Literature ◽

Current Evidence ◽

Aortic Cross Clamp ◽

Prosthetic Valves ◽

Stentless Bioprostheses ◽

Valve In Valve ◽

Transcatheter Valve ◽

Rapid Deployment ◽

Bail Out

Background and aim of the study: Sutureless and rapid-deployment bioprostheses have been introduced as alternative to traditional prosthetic valves to reduce cardiopulmonary and aortic cross-clamp times during aortic valve replacement.These devices have been employed also in extremely demanding surgical settings as underlined in the present review. Methods: A search on PubMed and Medline databases aimed to identify, from the English literature, the reported cases where both sutureless and rapid- deployment prostheses were employed in challenging surgical situations, usually complex reoperations sometimes even performed as a bail out procedures. Results: We have identified 25 patients in whom a sutureless or a rapid-deployment prosthesis were used in complex redo procedures. In 17 patients a failing stentless bioprosthesis was replaced with a sutureless (n=14) or a rapid deployment valve (n=3). Bioprostheses implanted at first operation were mainly Freestyle (n=11) or Prima Plus (n=3) aortic roots, while Perceval (n=13) and Intuity (n=3) were those most frequently employed at reoperation. A failing homograft was replaced in 6 patients using a Perceval (n=5) or an Intuity (n=1) bioprosthesis while a Perceval was used to replace the aortic valve in 2 patients to treat failure of a valve-sparing procedure. All patients survived reoperation and are reported alive 3 months to 4 years postoperatively. Conclusions: Sutureless and rapid-deployment bioprostheses have proved effective in replacing degenerated stentless bioprostheses and homografts in challenging redo procedures. In these setting, they should be considered as a valid alternative not only to traditional prostheses but also in selected cases to transcatheter valve-in-valve solutions.

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A valve-in-valve transcatheter aortic valve implantation with commissural alignment using advanced imaging reconstruction: a case report

Clinical Cardiology and Cardiovascular Interventions ◽

10.31579/2641-0419/090 ◽

2020 ◽

Vol 3 (10) ◽

pp. 01-05

Author(s):

Marco Angelillis

Keyword(s):

Aortic Valve ◽

Severe Aortic Stenosis ◽

Coronary Intervention ◽

Easy Access ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Structural Valve Deterioration ◽

Valve In Valve ◽

Transcatheter Valve ◽

Valve Implantation

Transcatheter valve in valve (ViV) implantation actually represents a valid alternative to surgical reinterventions in patients with previous surgical aortic valve replacement (AVR). In patients less than 80 years old, it is crucial to correctly position the new valve leaving a feasible and easy access to coronary ostia, both for future percutaneous coronary intervention (PCI) than for a future possible TAVinTAV procedure. We report a 71 year old man with prior AVR presented with structural valve deterioration (SVD) leading to severe aortic stenosis. In order to guarantee comfortable coronary access we aligned, the commissures of the new percutaneous valve with the ones of the surgical bioprothesis by reconstructing the headframes of the surgical bioprosthesis with computer tomography (CT) and fluoro-CT.

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