Thorac Cardiovasc Surg 2020; 68(07): 595-601
DOI: 10.1055/s-0039-1685178
Original Cardiovascular

Intermediate Outcomes after Rapid Deployment Aortic Valve Replacement in Multiple Valve Surgery

Markus Schlömicher
1   Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
,
Matthias Bechtel
1   Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
,
Zulfugar Taghiyev
1   Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
,
Hamid Naraghi
1   Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
,
Peter Lukas Haldenwang
1   Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
,
Vadim Moustafine
1   Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
,
Justus T. Strauch
1   Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
› Author Affiliations
Funding Statement No funding for this study was provided.

Abstract

Background Multiple valve surgery is associated with significant higher operative risks. Reduced cross-clamp and cardiopulmonary bypass times in multiple valve surgery may potentially be beneficial as they can be considered independent risk factors for increased morbidity and mortality following cardiac surgery. We report first intermediate outcomes of the Edwards Intuity valve system (Edwards Lifesciences, Irvine, California, United States) in combined procedures

Methods Fifty-eight patients underwent rapid deployment aortic valve replacement with concomitant mitral valve surgery between January 2014 and November 2017 in our institution. The valve was assessed echocardiographically after 12 months. The median follow-up was 1.7 years with a cumulative follow-up time of 115.3 patient years.

Results The mean age was 73.5 ± 6.2 years and the mean logistic Euroscore was 11.6 ± 3.1%. Concomitant mitral valve repair was performed in 43 cases (74.1%), and mitral valve replacement in 15 cases (19.0%). The mean cross-clamp time was 93 ± 21 minutes along with a mean bypass time of 118 ± 24 minutes. All-cause mortality after 30 days was 8.6%. Overall actuarial survival at 1 year was 87.2 ± 4.5% and after 2 years 82.8 ± 5.3%, respectively.

Conclusions Rapid deployment aortic valve replacement in multiple valve surgery can be performed safely with good intermediate outcomes in elderly, high-risk patients.

Freedom of Investigation Statement

The authors confirm that they had full freedom of investigation, full control of the design of the study, methods used, outcome parameters and results, analysis of data, and production of the written report.




Publication History

Received: 11 November 2018

Accepted: 26 February 2019

Article published online:
19 April 2019

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Borger MA, Moustafine V, Conradi L. et al. A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement. Ann Thorac Surg 2015; 99 (01) 17-25
  • 2 Schlömicher M, Haldenwang PL, Moustafine V, Bechtel M, Strauch JT. Minimal access rapid deployment aortic valve replacement: initial single-center experience and 12-month outcomes. J Thorac Cardiovasc Surg 2015; 149 (02) 434-440
  • 3 Schlömicher M, Taghiyev Z, AlJabery Y. et al. Rapid deployment aortic valve replacement in a minimal access setting: intermediate clinical and echocardiographic outcomes. Eur J Cardiothorac Surg 2018; 54 (02) 354-360
  • 4 Al-Sarraf N, Thalib L, Hughes A. et al. Cross-clamp time is an independent predictor of mortality and morbidity in low- and high-risk cardiac patients. Int J Surg 2011; 9 (01) 104-109
  • 5 Bechtel M, Schlömicher M, Moustafine V, Strauch JT. Rapid deployment aortic valve replacement in the setting of concomitant mitral valve procedures. Eur J Cardiothorac Surg 2017; 51 (04) 792-793
  • 6 Schlömicher M, Bechtel M, Taghiyev Z. et al. The use of rapid deployment valves in combined aortic and mitral valve surgery: one-year clinical and echocardiographic outcomes. Innovations (Phila) 2017; 12 (03) 201-206
  • 7 Zoghbi WA, Chambers JB, Dumesnil JG. et al; American Society of Echocardiography's Guidelines and Standards Committee, Task Force on Prosthetic Valves, American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, European Association of Echocardiography, European Society of Cardiology, Japanese Society of Echocardiography, Canadian Society of Echocardiography, American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, European Society of Cardiology, Japanese Society of Echocardiography, Canadian Society of Echocardiography. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound. J Am Soc Echocardiogr 2009; 22 (09) 975-1014 , quiz 1082–1084
  • 8 Akins CW, Miller DC, Turina MI. et al; STS, AATS, EACTS. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Ann Thorac Surg 2008; 85 (04) 1490-1495
  • 9 Kocher AA, Laufer G, Haverich A. et al. One-year outcomes of the TRITON trial: a prospective multicenter study of rapid deployment aortic valve replacement with the EDWARDS INTUITY valve system. J Thorac Cardiovasc Surg 2013; 145: 110-115
  • 10 Nishimura RA, Otto CM, Bonow RO. et al. American Heart Association 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg 2014; 148 (01) e1-e132
  • 11 Litmathe J, Boeken U, Kurt M, Feindt P, Gams E. Predictive risk factors in double-valve replacement (AVR and MVR) compared to isolated aortic valve replacement. Thorac Cardiovasc Surg 2006; 54 (07) 459-463
  • 12 Sheikh AM, Elhenawy AM, Maganti M, Armstrong S, David TE, Feindel CM. Outcomes of double valve surgery for active infective endocarditis. J Thorac Cardiovasc Surg 2009; 138 (01) 69-75
  • 13 Minh TH, Mazine A, Bouhout I. et al. Expanding the indication for sutureless aortic valve replacement to patients with mitral disease. J Thorac Cardiovasc Surg 2014; 148 (04) 1354-1359
  • 14 Schlömicher M, Haldenwang PL, Moustafine V, Bechtel M, Strauch JT. Simultaneous double valve-in-valve TAVI procedure for failed bioprostheses. Ann Thorac Surg 2015; 99 (02) 722-724
  • 15 Galloway AC, Grossi EA, Baumann FG. et al. Multiple valve operation for advanced valvular heart disease: results and risk factors in 513 patients. J Am Coll Cardiol 1992; 19 (04) 725-732
  • 16 Leavitt BJ, Baribeau YR, DiScipio AW. et al; Northern New England Cardiovascular Disease Study Group. Outcomes of patients undergoing concomitant aortic and mitral valve surgery in northern new England. Circulation 2009; 120 (11, Suppl): S155-S162
  • 17 Hannan EL, Racz MJ, Jones RH. et al. Predictors of mortality for patients undergoing cardiac valve replacements in New York State. Ann Thorac Surg 2000; 70 (04) 1212-1218
  • 18 Hellgren L, Kvidal P, Ståhle E. Improved early results after heart valve surgery over the last decade. Eur J Cardiothorac Surg 2002; 22 (06) 904-911
  • 19 Gillinov AM, Blackstone EH, Cosgrove III DM. et al. Mitral valve repair with aortic valve replacement is superior to double valve replacement. J Thorac Cardiovasc Surg 2003; 125 (06) 1372-1387
  • 20 Baran C, Durdu MS, Gumus F. et al. Sutureless aortic valve replacement with concomitant valvular surgery. J Thorac Cardiovasc Surg 2018; 155 (06) 2414-2422 . pii: S0022–5223(18)30407–0. doi: 10.1016/j.jtcvs.2017.12.154
  • 21 Haverich A, Wahlers TC, Borger MA. et al. Three-year hemodynamic performance, left ventricular mass regression, and prosthetic-patient mismatch after rapid deployment aortic valve replacement in 287 patients. J Thorac Cardiovasc Surg 2014; 148 (06) 2854-2860
  • 22 Barnhart GR, Accola KD, Grossi EA. et al; TRANSFORM Trial Investigators. TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) US clinical trial: performance of a rapid deployment aortic valve. J Thorac Cardiovasc Surg 2017; 153 (02) 241-251.e2
  • 23 Folliguet TA, Laborde F, Zannis K, Ghorayeb G, Haverich A, Shrestha M. Sutureless Perceval aortic valve replacement: results of two European centers. Ann Thorac Surg 2012; 93 (05) 1483-1488
  • 24 Dalmau MJ, González-Santos JM, Blázquez JA. et al. Hemodynamic performance of the Medtronic Mosaic and Perimount Magna aortic bioprostheses: five-year results of a prospectively randomized study. Eur J Cardiothorac Surg 2011; 39 (06) 844-852 , discussion 852
  • 25 Dellgren G, David TE, Raanani E, Armstrong S, Ivanov J, Rakowski H. Late hemodynamic and clinical outcomes of aortic valve replacement with the Carpentier-Edwards Perimount pericardial bioprosthesis. J Thorac Cardiovasc Surg 2002; 124 (01) 146-154
  • 26 Leyva F, Qiu T, McNulty D, Evison F, Marshall H, Gasparini M. Long-term requirement for pacemaker implantation after cardiac valve replacement surgery. Heart Rhythm 2017; 14 (04) 529-534