TY - JOUR
T1 - International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches
AU - Glauber, Mattia
AU - Moten, Simon C
AU - Quaini, Eugenio
AU - Solinas, Marco
AU - Folliguet, Thierry A
AU - Meuris, Bart
AU - Miceli, Antonio
AU - Oberwalder, Peter J
AU - Rambaldini, Manfredo
AU - Teoh, Kevin H T
AU - Bhatnagar, Gopal
AU - Borger, Michael A
AU - Bouchard, Denis
AU - Bouchot, Olivier
AU - Clark, Stephen C
AU - Dapunt, Otto E
AU - Ferrarini, Matteo
AU - Fischlein, Theodor J M
AU - Laufer, Guenther
AU - Mignosa, Carmelo
AU - Millner, Russell
AU - Noirhomme, Philippe
AU - Pfeiffer, Steffen
AU - Ruyra-Baliarda, Xavier
AU - Shrestha, Malakh Lal
AU - Suri, Rakesh M
AU - Troise, Giovanni
AU - Gersak, Borut
PY - 2016/5/1
Y1 - 2016/5/1
N2 - OBJECTIVE: To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement.METHODS: A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach.RESULTS: No guideline could be retrieved. Thirty-three clinical trials and 9 systematic reviews could be identified for detailed text analysis to obtain a total of 24 recommendations. After rating by the experts 12, final recommendations were identified: preoperative computed tomographic scan as well as intraoperative transesophageal echocardiography are highly recommended. Suitable annular sizes are 19 to 27 mm. There is a contraindication for bicuspid valves only for type 0 and for annular abscess or destruction due to infective endocarditis. The use of sutureless and rapid deployment valves reduces extracorporeal circulation and aortic cross-clamp time and leads to less early complications as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions, paravalvular leakages and aortic regurgitation, and renal replacement therapy, respectively. These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs. The use of sutureless and rapid deployment valves will lead to a higher adoption rate of minimally invasive approaches in aortic valve replacement. Respect should be taken to a necessary short learning curve for both sutureless and minimally invasive programs.CONCLUSIONS: Sutureless and rapid deployment aortic valve replacement together with minimally invasive approaches offers an attractive option in aortic valve placement for patients requiring biological valve replacement.
AB - OBJECTIVE: To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement.METHODS: A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach.RESULTS: No guideline could be retrieved. Thirty-three clinical trials and 9 systematic reviews could be identified for detailed text analysis to obtain a total of 24 recommendations. After rating by the experts 12, final recommendations were identified: preoperative computed tomographic scan as well as intraoperative transesophageal echocardiography are highly recommended. Suitable annular sizes are 19 to 27 mm. There is a contraindication for bicuspid valves only for type 0 and for annular abscess or destruction due to infective endocarditis. The use of sutureless and rapid deployment valves reduces extracorporeal circulation and aortic cross-clamp time and leads to less early complications as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions, paravalvular leakages and aortic regurgitation, and renal replacement therapy, respectively. These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs. The use of sutureless and rapid deployment valves will lead to a higher adoption rate of minimally invasive approaches in aortic valve replacement. Respect should be taken to a necessary short learning curve for both sutureless and minimally invasive programs.CONCLUSIONS: Sutureless and rapid deployment aortic valve replacement together with minimally invasive approaches offers an attractive option in aortic valve placement for patients requiring biological valve replacement.
KW - Aortic Valve Stenosis
KW - Clinical Trials as Topic
KW - Evidence-Based Medicine
KW - Heart Valve Prosthesis Implantation
KW - Humans
KW - Minimally Invasive Surgical Procedures
KW - Suture Techniques
KW - Consensus Development Conference
U2 - 10.1097/IMI.0000000000000287
DO - 10.1097/IMI.0000000000000287
M3 - Article
C2 - 27540996
SN - 1556-9845
VL - 11
SP - 165
EP - 173
JO - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
JF - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
IS - 3
ER -