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International expert consensus on sutureless and rapid deployment valves in aortic valve replacement using minimally invasive approaches

Lookup NU author(s): Stephen Clark

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Abstract

© 2016 by the International Society for Minimally Invasive Cardiothoracic Surgery.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 valveswas 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 tomographic 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.

Publication metadata

Author(s): Glauber M, Moten SC, Quaini E, Solinas M, Folliguet TA, Meuris B, Miceli A, Oberwalder PJ, Rambaldini M, Teoh KHT, Bhatnagar G, Borger MA, Bouchard D, Bouchot O, Clark SC, Dapunt OE, Ferrarini M, Fischlein TJM, Laufer G, Mignosa C, Millner R, Noirhomme P, Pfeiffer S, Ruyra-Baliarda X, Shrestha ML, Suri RM, Troise G, Gersak B

Publication type: Article

Publication status: Published

Journal: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

Year: 2016

Volume: 11

Issue: 3

Pages: 165-173

Online publication date: 01/05/2016

Acceptance date: 29/02/2016

Date deposited: 26/04/2017

ISSN (print): 1556-9845

ISSN (electronic): 1559-0879

Publisher: Lippincott Williams and Wilkins

URL: http://doi.org/10.1097/IMI.0000000000000287

DOI: 10.1097/IMI.0000000000000287

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