Anthony Nguyen1, William Fortin2, Amine Mazine2, Denis Bouchard1, Michel Carrier1, Ismail El Hamamsy1, Yoan Lamarche1, Philippe Demers3. 1. Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; University of Montreal, Montreal, Quebec, Canada. 2. University of Montreal, Montreal, Quebec, Canada. 3. Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; University of Montreal, Montreal, Quebec, Canada. Electronic address: philippe.demers@icm-mhi.org.
Abstract
OBJECTIVE: Bicuspid aortic valve (BAV) is generally considered to be a contraindication to sutureless aortic valve replacement (AVR). The aim of this study was to evaluate the feasibility and perioperative outcomes of this technique in patients with BAV. METHODS: From June 2011 to January 2014, a total of 25 patients who underwent sutureless AVR had documented BAV. Thirteen patients (52%) had median sternotomy, and 12 patients (48%) a minimally invasive approach. RESULTS: The study population included 17 (68%) men with a median age of 77.8 ± 5.4 years. The mean EuroSCORE II was 3.4% ± 2.6%. Concomitant procedures included coronary artery bypass grafting in 8 patients (32%), 2 AVRs (8%), 1 mitral valve repair (4%), 1 septal myomectomy (4%), and 1 atrial septal defect closure (4%). The mean transaortic valve gradient decreased from 49.4 ± 15.7, to 14.5 ± 5.4 mm Hg postoperatively. The mean aortic valve area increased from 0.78 ± 0.18, to 1.75 ± 0.43 cm(2) postoperatively. Five patients (20%) suffered from atrioventricular block that required permanent pacemaker implantation. Two patients (8%) suffered a stroke. No major paravalvular leakage occurred, and no postoperative valve migration. In-hospital mortality occurred in 1 patient (4%). The mean intensive care unit length of stay was 3 ± 2 days postoperatively. CONCLUSIONS: This study demonstrates that a sutureless aortic valve can be deployed in patients with BAV without increasing the risk of paravalvular leakage. BAV should not be considered a contraindication to sutureless AVR.
OBJECTIVE:Bicuspid aortic valve (BAV) is generally considered to be a contraindication to sutureless aortic valve replacement (AVR). The aim of this study was to evaluate the feasibility and perioperative outcomes of this technique in patients with BAV. METHODS: From June 2011 to January 2014, a total of 25 patients who underwent sutureless AVR had documented BAV. Thirteen patients (52%) had median sternotomy, and 12 patients (48%) a minimally invasive approach. RESULTS: The study population included 17 (68%) men with a median age of 77.8 ± 5.4 years. The mean EuroSCORE II was 3.4% ± 2.6%. Concomitant procedures included coronary artery bypass grafting in 8 patients (32%), 2 AVRs (8%), 1 mitral valve repair (4%), 1 septal myomectomy (4%), and 1 atrial septal defect closure (4%). The mean transaortic valve gradient decreased from 49.4 ± 15.7, to 14.5 ± 5.4 mm Hg postoperatively. The mean aortic valve area increased from 0.78 ± 0.18, to 1.75 ± 0.43 cm(2) postoperatively. Five patients (20%) suffered from atrioventricular block that required permanent pacemaker implantation. Two patients (8%) suffered a stroke. No major paravalvular leakage occurred, and no postoperative valve migration. In-hospital mortality occurred in 1 patient (4%). The mean intensive care unit length of stay was 3 ± 2 days postoperatively. CONCLUSIONS: This study demonstrates that a sutureless aortic valve can be deployed in patients with BAV without increasing the risk of paravalvular leakage. BAV should not be considered a contraindication to sutureless AVR.
Authors: Antonio Miceli; Paolo Berretta; Antonio Fiore; Martin Andreas; Marco Solinas; Giuseppe Santarpino; Utz Kappert; Martin Misfeld; Carlo Savini; Alberto Albertini; Emmanuel Villa; Kevin Phan; Theodor Fischlein; Bart Meuris; Gianluca Martinelli; Kevin Teoh; Carmelo Mignosa; Malakh Shrestha; Thierry P Carrel; Tristan D Yan; Mattia Glauber; Marco Di Eusanio Journal: Ann Cardiothorac Surg Date: 2020-07