Format

Send to

Choose Destination
Eur J Cardiothorac Surg. 2016 Mar;49(3):709-18. doi: 10.1093/ejcts/ezv369. Epub 2015 Oct 29.

Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel.

Author information

1
University of Ljubljana School of Medicine and University Medical Center Ljubljana, Ljubljana, Slovenia bgersak@maat.si.
2
Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany.
3
Centre Hospitalo-Universitaire Brabois, Université de Lorraine, Vandoeuvre les Nancy, France.
4
U.Z. Gasthuisberg, Leuven, Belgium.
5
McMaster University, Hamilton, ON, Canada.
6
Austin Health and Royal Melbourne Hospital, Melbourne, Australia.
7
Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
8
Istituto Clinico Humanitas, Milan, Italy.
9
Medical School Graz, Graz, Austria.
10
Ospedale di Mantova, Mantua, Italy.
11
Trillium Cardiovascular Associates, Mississauga, ON, Canada.
12
Columbia University Medical Center, New York, NY, USA.
13
University of Montreal, Montreal, QC, Canada.
14
CHU le Bocage, Dijon, France.
15
Freeman Hospital, Newcastle, UK.
16
Istituto Clinico Sant' Ambrogio, Milan, Italy.
17
Medizinische Universitaet Wien, Vienna, Austria.
18
Ospedale Ferrarotto, Catania, Italy.
19
Blackpool Victoria Hospital, Blackpool, UK.
20
Cliniques Universitaires St-Luc, Brussels, Belgium.
21
Hospital University Germans Trias I Pujol, Barcelona, Spain.
22
Medizinischen Hochschule Hannover, Hannover, Germany.
23
Mayo Clinic, Rochester, MN, USA.
24
Fondazione Poliambulanza, Brescia, Italy.
25
Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt an der Saale, Germany.
26
Institut Mutualiste Montsouris, Paris, France.
27
University Hospital Dupuytren, Limoges, France.
28
King Fahad National Guard Hospital, Riyadh, Saudi Arabia.

Abstract

OBJECTIVES:

After a panel process, recommendations on the use of sutureless and rapid deployment valves in aortic valve replacement were given with special respect as an alternative to stented valves.

METHODS:

Thirty-one international experts in both sutureless, rapid deployment valves and stented bioprostheses constituted the panel. After a thorough literature review, evidence-based recommendations were rated in a three-step modified Delphi approach by the experts.

RESULTS:

Literature research could identify 67 clinical trials, 4 guidelines and 10 systematic reviews for detailed text analysis to obtain a total of 28 recommendations. After rating by the experts, 12 recommendations were identified and degree of consensus for each was determined. Proctoring and education are necessary for the introduction of sutureless valves on an institutional basis as well as for the individual training of surgeons. Sutureless and rapid deployment should be considered as the valve prosthesis of first choice for isolated procedures in patients with comorbidities, old age, delicate aortic wall conditions such as calcified root, porcelain aorta or prior implantation of aortic homograft and stentless valves as well as for concomitant procedures and small aortic roots to reduce cross-clamp time. Intraoperative transoesophageal echocardiography is highly recommended, and in case of right anterior thoracotomy, preoperative computer tomography is strongly recommended. Suitable annular sizes are 19-27 mm. There is a contraindication for bicuspid valves only for Type 0 and for annular abscess or destruction due to infective endocarditis. Careful but complete decalcification of the aortic root is recommended to avoid paravalvular leakage; extensive decalcification should be avoided not to create annular defects. Proximal anastomoses of concomitant coronary artery bypass grafting should be placed during a single aortic cross-clamp period or alternatively with careful side clamping. Available evidence suggests that the use of sutureless and rapid deployment valve is associated with (can translate into) reduced early complications such as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions and renal replacement therapy, respectively, and may result in reduced intensive care unit and hospital stay in comparison with traditional valves.

CONCLUSION:

The international experts recommend various benefits of sutureless and rapid deployment technology, which may represent a helpful tool in aortic valve replacement for patients requiring a biological valve. However, further evidence will be needed to reaffirm the benefit of sutureless and rapid deployment valves.

KEYWORDS:

Aortic valve replacement; Rapid deployment valve; Recommendations; Stented aortic valve prosthesis; Sutureless valve

PMID:
26516193
DOI:
10.1093/ejcts/ezv369
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center