Intermediate Results after Minimal Access Rapid Deployment Aortic Valve Replacement: Clinical and Echocardiographic Outcomes

Objectives: Rapid deployment aortic valves were mainly developed to simplify and accelerate minimal access surgery. We report intermediate clinical and echocardiographic outcomes after minimally invasive aortic valve replacement with the Edwards Intuity valve system.

Methods: 143 patients underwent rapid deployment AVR via upper right hemisternotomy or right anterior thoracotomy between March 2012 and September 2015.

All patients were prospectively followed on an annual basis. Follow-up data concerning valve related events was obtained through telephone interviews with patients, relatives and referring physicians. Echocardiographic assessment of the valve was performed after 12 months. The cumulative follow up time was 275 patient years. The median follow up time 1.9 years. A follow up rate of 98% was achieved.

Results: The mean age was 76.5 ± 6.2 years and the mean logistic EuroScore 11.0 ± 4.3%. Thirty-day mortality was 2.8% (n = 4). Actuarial survival after 1 year was 91.6 ± 2.4% and after 3 years 84.4 ± 3.6%, respectively. After 12 months, the mean transprosthetic gradients were 9.7 ± 3.8 mm Hg. A mean EOA of 1.7 cm² (± 0.4) was measured. Higher grade paravalvular leakage (AI>1⁺) occurred in two cases (1.4%) perioperatively. New onset of higher grade paravalvular leakage did not occur during the follow up period. No case of early structural valve deterioration was observed while one case of endocarditis was seen.

Conclusion: Minimal access rapid deployment aortic valve replacement can be performed safely with low complication rates and low rates of paravalvular leakage in an intermediate risk patient cohort. New onset of paravalvular leakage in the postoperative follow up did not occur so far. Good follow-up outcomes underline the relevance of this evolving technique in the promotion and dissemination of minimal access aortic valve surgery.