title: Early outcomes after isolated aortic valve replacement with rapid deployment aortic valve.
abstract: OBJECTIVE
  Minimal access aortic valve replacement is associated with favorable clinical outcomes; however, several meta-analyses have reported significantly longer crossclamp times compared with a full sternotomy. We examined the procedural and early safety outcomes after isolated rapid deployment aortic valve replacement by surgical approach in patients enrolled in the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve trial.
  
  
  METHODS
  The Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve trial was a prospective, multicenter, single-arm study, with successful implants in 287 patients with aortic valve stenosis who underwent rapid deployment aortic valve replacement using the EDWARDS INTUITY Valve System (Edwards Lifesciences, Irvine, Calif). Patients were evaluated perioperatively for procedural times and technical success rates; at discharge, for hospital length of stay; and, at 30 days, for early adverse events.
  
  
  RESULTS
  A total of 158 patients underwent isolated aortic valve replacement through a full sternotomy (n = 71), upper hemisternotomy (n = 77), or right anterior thoracotomy (n = 10). Mean age at baseline was 75.7 ± 7.2 years. Mean aortic crossclamp and cardiopulmonary bypass times (minutes) were similar for full sternotomy and upper hemisternotomy, 43.5 ± 32.5/71.6 ± 41.8 and 43.1 ± 13.1/69.6 ± 19.1, respectively, and significantly longer for right anterior thoracotomy, 88.3 ± 18.6/122.2 ± 22.1 (P < .000). Early adverse event rates were similar, and in-hospital mortality rates were low regardless of surgical approach.
  
  
  CONCLUSIONS
  These data suggest that isolated rapid deployment aortic valve replacement through an upper hemisternotomy can lead to shorter crossclamp times than has been reported historically in the literature. This may facilitate minimal access aortic valve replacement by eliminating the issue of prolonged crossclamp times. Further, low in-hospital mortality and new permanent pacemaker implant rates were observed regardless of surgical approach.
authors.affiliation: Medical University of Cologne, Cologne, Germany. Electronic address: thorsten.wahlers@uk-koeln.de.
authors.forename: Thorsten C W
authors.initials: TC
authors.lastname: Wahlers
authors.affiliation: Medical University of Hannover, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Heart Center Leipzig, Leipzig, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Medical University of Hannover, Hannover, Germany.
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Kocher
authors.affiliation: Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.affiliation: Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Roth
authors.affiliation: Heart Center Leipzig, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.affiliation: Heart Center Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Kempfert
authors.affiliation: University of Leipzig, Leipzig, Germany.
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Dohmen
authors.affiliation: University of Munich, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.affiliation: Medical University of Cologne, Cologne, Germany.
authors.forename: Parwis
authors.initials: P
authors.lastname: Rahmanian
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Dominik
authors.initials: D
authors.lastname: Wiedemann
authors.affiliation: Edwards Lifesciences LLC, Irvine, Calif.
authors.forename: Francis G
authors.initials: FG
authors.lastname: Duhay
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Günther
authors.initials: G
authors.lastname: Laufer
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011474:Prosthesis Design; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: aortic valve; bioprosthesis; heart valve; hemodynamics; replacement