Rapid deployment valve system shortens operative times for aortic valve replacement through right anterior minithoracotomyReportar como inadecuado




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Journal of Cardiothoracic Surgery

, 12:27

First Online: 16 May 2017Received: 27 July 2016Accepted: 10 May 2017DOI: 10.1186-s13019-017-0598-0

Cite this article as: Bening, C., Hamouda, K., Oezkur, M. et al. J Cardiothorac Surg 2017 12: 27. doi:10.1186-s13019-017-0598-0

Abstract

BackgroundThere is growing evidence from the literature that right anterior minithoracotomy aortic valve replacement RAT-AVR improves clinical outcome. However, increased cross clamp time is the strongest argument for surgeons not performing RAT-AVR. Rapid deployment aortic valve systems have the potential to decrease cross-clamp time and ease this procedure. We assessed clinical outcome of rapid deployment and conventional valves through RAT.

MethodsSixty-eight patients mean age 76 ± 6 years, 32% females underwent RAT-AVR between 9-2013 and 7-2015. According to the valve type implanted the patients were divided into two groups. In 43 patients R-group; mean age 74.1 ± 6.6 years a rapid deployment valve system Edwards Intuity, Edwards Lifesciences Corp; Irvine, Calif and in 25 patients C-group; mean age 74.2 ± 6.6 years a conventional stented biological aortic valve was implanted.

ResultsAortic cross-clamp 42.1 ± 12 min vs. 68.3 ± 20.3 min; p < 0.001 and bypass time 80.4 ± 39.3 min vs. 106.6 ± 23.2 min; p = 0.001 were shorter in the rapid deployment group R-group. We observed no differences in clinical outcome. Postoperative gradients R-group: max gradient, 14.3 ± 8 mmHg vs. 15.5 ± 5 mmHg C-group, mean gradient, 9.2 ± 1.7 mmHg R-group vs. 9.1 ± 2.3 mmHg C-group revealed no differences. However, larger prostheses were implanted in C-group 25 mm; IQR 23–27 mm vs. 23 mm; IQR 21–25; p = 0.009.

ConclusionsOur data suggest that the rapid deployment aortic valve system reduced cross clamp and bypass time in patients undergoing RAT-AVR with similar hemodynamics as with larger size stented prosthesis. However, larger studies and long-term follow-up are mandatory to confirm our findings.

KeywordsAortic valve replacement Minimally invasive surgery Heart valve prosthesis biological rapid deployment aortic valve AbbreviationsAVRAortic valve replacement

CPBCardiopulmonary bypass

iEOAIndexed effective orifice area

PPMPatient prosthesis mismatch

RATRight anterior thoracotomy

RAT-AVRRight anterior thoracotomy-aortic valve replacement

RDRapid deployment





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Fuente: https://link.springer.com/







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