title: Rapid-Deployment Versus Conventional Bio-Prosthetic Aortic Valve Replacement.
abstract: BACKGROUND
  The use of rapid-deployment aortic valve replacement (RD-AVR) has burgeoned in recent years. There are few studies comparing RD-AVR to conventional aortic valve replacement (cAVR) and no studies where both were inserted via full sternotomy. As such, we reviewed our experience and compared the two approaches.
  
  
  METHODS
  From 2008 to 2015, 597 patients underwent isolated aortic valve replacement ± coronary artery bypass grafting (CABG) at a single centre. During this period, 41 (7%) patients received RD-AVR and 556 (93%) received cAVR. Of those receiving RD-AVR, surgical access was via full median sternotomy in 40 (98%). Propensity score matching yielded 41 matched pairs. Perioperative outcomes were compared.
  
  
  RESULTS
  After propensity score matching, the RD-AVR group had shorter aortic cross clamp (X-clamp) (RD-AVR: 71±33min vs. cAVR: 106±42min, p<0.01) and cardiopulmonary bypass (CPB) times (95±42min vs. 134±47min, p<0.01). There was no difference in 30-day mortality (RD-AVR: 2% vs. cAVR: 2%, p>0.99). RD-AVR patients required shorter mean ventilation (17±25 vs. 63±131hrs, p<0.01) and intensive care unit (ICU) stay (51±45 vs. 108±157hrs, p=0.03) times. RD-AVR also had reduced rates of new postoperative atrial arrhythmias (8% vs. 20%, p=0.02). Total length of postoperative hospital stay was similar. Haemodynamic performance for the RD-AVR was within acceptable limits.
  
  
  CONCLUSIONS
  The use of RD-AVR results in shorter X-clamp and CPB times and is associated with reductions in perioperative morbidity. RD-AVR is becoming a valuable component of the surgeon's armamentarium in selected patients. Long-term follow-up will reveal the full potential of these devices.
authors: Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Vic, Australia; School of Medicine, University of Melbourne, Melbourne, Vic, Australia.
authors: Andrew L
authors: AL
authors: Smith
authors: Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Vic, Australia; School of Medicine, University of Melbourne, Melbourne, Vic, Australia.
authors: William Y
authors: WY
authors: Shi
authors: Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Vic, Australia.
authors: Alexander
authors: A
authors: Rosalion
authors: Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Vic, Australia.
authors: Michael
authors: M
authors: Yii
authors: Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Vic, Australia.
authors: Michael
authors: M
authors: O'Keefe
authors: Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Vic, Australia; School of Medicine, University of Melbourne, Melbourne, Vic, Australia. Electronic address: Andrew.Newcomb@svha.org.au.
authors: Andrew E
authors: AE
authors: Newcomb
authors: Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Vic, Australia; School of Medicine, University of Melbourne, Melbourne, Vic, Australia.
authors: Philip
authors: P
authors: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology*; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D056346:Sternotomy / Q000009:adverse effects
keywords: Aortic stenosis; Aortic valve; Cardiac surgical procedures; Cardiopulmonary bypass.; Rapid deployment aortic valve replacement; Thoracic surgery