title: Aortic cross-clamp time, new prostheses, and outcome in aortic valve replacement.
abstract: OBJECTIVE
  A number of sutureless bioprosthetic aortic valves have been recently introduced in clinical practice, their main advantage being a reduction in the aortic cross-clamp time (AXCT). The study aim was to investigate if AXCT was a determinant of cardiovascular morbidity in patients undergoing surgical aortic valve replacement (AVR) to treat aortic valve stenosis, and to identify any subset of patients who might benefit from a reduction in AXCT.
  
  
  METHODS
  A retrospective analysis was conducted of 979 consecutive patients with aortic valve stenosis who underwent surgical AVR. The AXCT was analyzed as an independent predictor of severe cardiovascular morbidity, defined as the presence of a low cardiac output, stroke, acute kidney injury, or operative mortality. Subgroups of patients who benefited more from a reduction in AXCT were investigated.
  
  
  RESULTS
  The AXCT was an independent predictor of severe cardiovascular morbidity, with an increased risk of 1.4% per 1 min increase. Patients with a left ventricular ejection fraction < or = 40%, and also diabetic patients, showed the most relevant clinical benefits induced by a reduction in AXCT.
  
  
  CONCLUSIONS
  In selected patient populations at high risk of systolic dysfunction, the use of sutureless aortic valve bioprostheses may be considered. However, the routine use of such bioprostheses should be pondered within a cost-benefit analysis.
authors: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy. cardioanestesia@virgilio.it
authors: Marco
authors: M
authors: Ranucci
authors: Alessandro
authors: A
authors: Frigiola
authors: Lorenzo
authors: L
authors: Menicanti
authors: Serenella
authors: S
authors: Castelvecchio
authors: Carlo
authors: C
authors: de Vincentiis
authors: Valeria
authors: V
authors: Pistuddi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D003250:Constriction; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left