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Initial Experience of Edwards Intuity Elite Rapid Deployment Aortic Valve Replacement
Sue Hyun Kim, MD, Hak Ju kim, MD, Jae Woong Choi, MD, Kyung Hwan Kim, MD, PhD
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Purpose : Rapid deployment aortic valve replacement (RDAVR) represents a smart alternative to the standard surgical aortic valve replacement with the potential to simplify the procedure. But there are still controversies of RDAVR in patients with pure aortic valve regurgitation or true bicuspid aortic valve due to the risk of paravalvular leak. We examined the procedural and early safety outcomes after RDAVR.
Methods : Between June 2016 and July 2017, 40 patients underwent RDAVR through a full sternotomy (mean age, 69.8 ± 9.6 years; 50.0% were female). 32.5% of cases had isolated aortic valve replacement, and 67.5% of cases involved concomitant procedures. 5mm video-scope was used to confirm the proper valve position after delivery. Reinforcement sutures were placed additionally to the three guiding sutures at the nadir of the each aortic cusp if there was possible gap between the prosthetic valve and aortic annulus.
Results : 33 patients (82.5%) had severe aortic stenosis, 3 patients (7.5%) had aortic stenoinsufficiency, and 4 patients (10.0%) had aortic regurgitation. Bicuspid aortic valve was found in 23 patients (57.5%) intraoperatively. 24 patients (60.0%) required additional reinforcement sutures with mean number of 3.0 ± 1.2. Technical success of implantation was 100%. There was 1 case (2.6%) of mild paravalvular leak at postoperative echocardiography without clinical significance. None of the patients required permanent pacemaker implantation. 2 patients (5.0%) with preoperative other co-morbidities had operative mortality, but not valve-related.
Conclusion : RDAVR provided favorable outcome in patients with aortic stenosis and feasible with bicuspid aortic valve. RDAVR could be considered even with pure aortic regurgitation.
Methods : Between June 2016 and July 2017, 40 patients underwent RDAVR through a full sternotomy (mean age, 69.8 ± 9.6 years; 50.0% were female). 32.5% of cases had isolated aortic valve replacement, and 67.5% of cases involved concomitant procedures. 5mm video-scope was used to confirm the proper valve position after delivery. Reinforcement sutures were placed additionally to the three guiding sutures at the nadir of the each aortic cusp if there was possible gap between the prosthetic valve and aortic annulus.
Results : 33 patients (82.5%) had severe aortic stenosis, 3 patients (7.5%) had aortic stenoinsufficiency, and 4 patients (10.0%) had aortic regurgitation. Bicuspid aortic valve was found in 23 patients (57.5%) intraoperatively. 24 patients (60.0%) required additional reinforcement sutures with mean number of 3.0 ± 1.2. Technical success of implantation was 100%. There was 1 case (2.6%) of mild paravalvular leak at postoperative echocardiography without clinical significance. None of the patients required permanent pacemaker implantation. 2 patients (5.0%) with preoperative other co-morbidities had operative mortality, but not valve-related.
Conclusion : RDAVR provided favorable outcome in patients with aortic stenosis and feasible with bicuspid aortic valve. RDAVR could be considered even with pure aortic regurgitation.
책임저자: Kyung Hwan Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
발표자: Sue Hyun Kim, E-mail : annesue01@gmail.com