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A new technique that prevents paravalvular leakage after aortic valve replacement using a rapid deployment valve system
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  • Taira Yamamoto,
  • Daisuke Endo,
  • Hironobu Yamaoka,
  • Satoshi Matsushita,
  • Kan Kajimoto,
  • Tohru Asai,
  • Atsushi Amano
Taira Yamamoto
Juntendo University
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Daisuke Endo
Juntendo University - Hongo Campus
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Hironobu Yamaoka
Edogawa Hospital
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Satoshi Matsushita
Juntendo University
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Kan Kajimoto
Juntendo University
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Tohru Asai
Juntendo University
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Atsushi Amano
Juntendo University
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Abstract

Background and aim of the study: We report our one-year single-center experience of a new technique of aortic valve replacement using a rapid-deployment valve (RD-AVR) to avoid postoperative complications. We also report the unexpected pitfalls and handling techniques that we have seen in past cases. Methods: We performed aortic valve replacement on 38 patients between May 2019 and April 2020. Their mean age was 74 years. The primary outcomes were in-hospital mortality and short-term results during a one-year follow-up period, while the secondary outcomes were related to prosthetic valve function, especially paravalvular leakage (PVL). We further analyzed the relationship between the new technique and its outcomes. Results: The mean operative time was 196 min. There were no in-hospital deaths, and the mean duration of postoperative hospital stay was 11.8 days. Valvular measurements using 3-dimensional computed tomography (3D-CT) were larger and more accurate than those measured using ultrasonic echocardiography Postoperative RD-AVR prosthetic valve function was excellent. However, PVL occurred in 4 cases one week and one year postoperatively and regurgitation did not improve. A gap associated with PVL was identified below the right-noncoronary commissure. To prevent PVL, we additionally stitched this gap in the later 18 cases; there was no case of PVL and no new pacemaker implantation in these cases. Conclusions: PVL is more likely to occur if there is a gap below the R-N commissure, especially in cases with a large annulus; therefore, applying an additional stitch to the R-N commissure is extremely useful.

Peer review status:ACCEPTED

11 Jan 2021Submitted to Journal of Cardiac Surgery
11 Jan 2021Assigned to Editor
11 Jan 2021Submission Checks Completed
11 Jan 2021Reviewer(s) Assigned
31 Jan 2021Review(s) Completed, Editorial Evaluation Pending
31 Jan 2021Editorial Decision: Accept