Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations

Abstract

Sutureless or rapid deployment valves in the setting of aortic valve replacement (AVR) is an emerging surgical technique using the transcatheter valve technology, which may lead to reduction in cross-clamp time and potentially better hemodynamics compared to a stented bioprosthetic valve. The absence of subannular pledgets results to excellent hemodynamic performance with reduced turbulent flow and larger effective orifice area. However, complications from both surgical and transcatheter AVR may still occur and impact survival. The incidence of paravalvular leakage and permanent pacemaker implantation are not low. Although technical modifications can improve these outcomes, there is a learning curve effect. Therefore, technical and anatomical considerations as well as better patient selection are paramount for better outcomes. In this review, we discuss the use of sutureless or rapid deployment valves in setting of (1) complex procedures, (2) minimally invasive AVR, and (3) small aortic annulus. The advantage of sutureless or rapid deployment valves in terms of mortality remains to be clarified; therefore, it is necessary to accumulate long-term outcomes in an appropriate patient cohort.

Keywords:

• sutureless valve
• rapid deployment valve
• aortic valve replacement
• minimally invasive cardiac surgery
• paravalvular leakage
• permanent pacemaker implantation

Abbreviations

ART, Anterior right thoracotomy; AVR, Aortic valve replacement; AXC, Aortic cross clamp; BAV, Bicuspid aortic valve; CPB, Cardiopulmonary bypass; MICS, Minimally invasive cardiac surgery; PPI, Permanent pacemaker implantation; PPM, Patient-prosthesis mismatch; PVL, Paravalvular leakage; SAVR, Surgical aortic valve replacement; SRDV, Sutureless and/or rapid deployment valve; STJ, Sinotubular junction; TAVR, Transcatheter aortic valve replacement.

Disclosure

The authors report no conflicts of interest in this work.