Universität zu Köln

Rahmanian, Parwis B. ORCID: 0000-0002-3978-9251, Kaya, Suereyya, Eghbalzadeh, Kaveh, Menghesha, Hruy, Madershahian, Navid and Wahlers, Thorsten (2018). Rapid Deployment Aortic Valve Replacement: Excellent Results and Increased Effective Orifice Areas. Ann. Thorac. Surg., 105 (1). S. 24 - 31. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1552-6259

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Abstract

Background. The aim of this study was to evaluate the effects of rapid deployment aortic valve replacement (RDAVR) on surgical outcome and hemodynamics compared with standard aortic valve replacement (AVR). Methods. One hundred sixty- three RDAVR patients (isolated, n = 67; combined with coronary artery bypass graft surgery [CABG], n = 96) were compared with a propensity matched control group (n = 163). Primary endpoints included association between valve type and procedure times, prosthesis size, transvalvular gradient, and indexed effective orifice area. Secondary endpoints were postoperative mortality and morbidity. Results. Aortic cross-clamp and cardiopulmonary bypass times in the RDAVR group were 55 +/- 23 and 88 +/- 38 minutes, respectively, compared with 77 +/- 22 and 105 +/- 38 minutes in the control group (p < 0.001). In the subgroup of patients undergoing isolated RDAVR (n = 67 of 163), the aortic cross-clamp and cardiopulmonary bypass times were 38 +/- 13 and 66 +/- 22 minutes, respectively, compared with 55 +/- 14 and 81 +/- 18 minutes in the control group (n = 67 of 163; p < 0.001). The RDAVR patients received larger prostheses (23.3 +/- 1.8 mm) compared with standard AVR (22.8 +/- 1.5 mm; p = 0.002). Mean transvalvular gradients and indexed effective orifice areas were 9 +/- 5 mm Hg and 1.11 +/- 0.11, respectively, in the RDVAR group compared with 13 +/- 5 mm Hg and 0.95 +/- 0.08 in the control group (p < 0.001). Hospital mortality was similar in both groups (1.8%, n = 3 of 163; p = 1.000). Postoperative pacemaker rates were 3.5% (n = 3 of 67) for isolated RDAVR versus 3.0% (n = 2 of 67; p = 0.649) for isolated AVR and 12.5% (n = 12 of 96) for RDAVR/CABG versus 4.2% (n = 4 of 96; p = 0.032) for AVR/CABG. Conclusions. RDAVR facilitates reduced aortic crossclamp and cardiopulmonary bypass times compared with standard AVR, particularly in patients undergoing concomitant procedures, allowing the use of larger prostheses and resulting in lower transvalvular gradients and higher indexed effective orifice area compared with standard AVR. Therefore, RDAVR may help to overcome patient-prosthesis mismatch in some patients. (C) 2018 by The Society of Thoracic Surgeons

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Rahmanian, Parwis B. UNSPECIFIED orcid.org/0000-0002-3978-9251 UNSPECIFIED Kaya, Suereyya UNSPECIFIED UNSPECIFIED UNSPECIFIED Eghbalzadeh, Kaveh UNSPECIFIED UNSPECIFIED UNSPECIFIED Menghesha, Hruy UNSPECIFIED UNSPECIFIED UNSPECIFIED Madershahian, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-204430
DOI:	10.1016/j.athoracsur.2017.07.047
Journal or Publication Title:	Ann. Thorac. Surg.
Volume:	105
Number:	1
Page Range:	S. 24 - 31
Date:	2018
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1552-6259
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PERMANENT PACEMAKER IMPLANTATION; SUTURELESS; BIOPROSTHESIS; OUTCOMES; PERFORMANCE Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/20443