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Title: Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel.
Austin Authors: Gersak, Borut;Fischlein, Theodor;Folliguet, Thierry A;Meuris, Bart;Teoh, Kevin H T;Moten, Simon C;Solinas, Marco;Miceli, Antonio;Oberwalder, Peter J;Rambaldini, Manfredo;Bhatnagar, Gopal;Borger, Michael A;Bouchard, Denis;Bouchot, Olivier;Clark, Stephen C;Dapunt, Otto E;Ferrarini, Matteo;Laufer, Guenther;Mignosa, Carmelo;Millner, Russell;Noirhomme, Philippe;Pfeiffer, Steffen;Ruyra-Baliarda, Xavier;Shrestha, Malakh;Suri, Rakesh M;Troise, Giovanni;Diegeler, Anno;Laborde, Francois;Laskar, Marc;Najm, Hani K;Glauber, Mattia
Affiliation: University of Ljubljana School of Medicine and University Medical Center Ljubljana, Ljubljana, Slovenia
Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany
Centre Hospitalo-Universitaire Brabois, Université de Lorraine, Vandoeuvre les Nancy, France
U.Z. Gasthuisberg, Leuven, Belgium
McMaster University, Hamilton, ON, Canada
Austin Health, Heidelberg, Victoria, Australia
Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy
Istituto Clinico Humanitas, Milan, Italy
Ospedale di Mantova, Mantua, Italy
Trillium Cardiovascular Associates, Mississauga, ON, Canada
Columbia University Medical Center, New York, NY, USA
University of Montreal, Montreal, QC, Canada
CHU le Bocage, Dijon, France
Freeman Hospital, Newcastle, UK
Medical School Graz, Graz, Austria
Istituto Clinico Sant' Ambrogio, Milan, Italy
Medizinische Universitaet Wien, Vienna, Austria
Ospedale Ferrarotto, Catania, Italy
Blackpool Victoria Hospital, Blackpool, UK
Cliniques Universitaires St-Luc, Brussels, Belgium
Hospital University Germans Trias I Pujol, Barcelona, Spain
Medizinischen Hochschule Hannover, Hannover, Germany
Mayo Clinic, Rochester, MN, USA
Fondazione Poliambulanza, Brescia, Italy
Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt an der Saale, Germany
Institut Mutualiste Montsouris, Paris, France
University Hospital Dupuytren, Limoges, France
King Fahad National Guard Hospital, Riyadh, Saudi Arabia
Royal Melbourne Hospital, Melbourne, Australia
Issue Date: Mar-2016 2015-10-29
Publication information: European journal of cardio-thoracic surgery 2016; 49(3): 709-18
Abstract: After a panel process, recommendations on the use of sutureless and rapid deployment valves in aortic valve replacement were given with special respect as an alternative to stented valves. Thirty-one international experts in both sutureless, rapid deployment valves and stented bioprostheses constituted the panel. After a thorough literature review, evidence-based recommendations were rated in a three-step modified Delphi approach by the experts. Literature research could identify 67 clinical trials, 4 guidelines and 10 systematic reviews for detailed text analysis to obtain a total of 28 recommendations. After rating by the experts, 12 recommendations were identified and degree of consensus for each was determined. Proctoring and education are necessary for the introduction of sutureless valves on an institutional basis as well as for the individual training of surgeons. Sutureless and rapid deployment should be considered as the valve prosthesis of first choice for isolated procedures in patients with comorbidities, old age, delicate aortic wall conditions such as calcified root, porcelain aorta or prior implantation of aortic homograft and stentless valves as well as for concomitant procedures and small aortic roots to reduce cross-clamp time. Intraoperative transoesophageal echocardiography is highly recommended, and in case of right anterior thoracotomy, preoperative computer tomography is strongly recommended. Suitable annular sizes are 19-27 mm. There is a contraindication for bicuspid valves only for Type 0 and for annular abscess or destruction due to infective endocarditis. Careful but complete decalcification of the aortic root is recommended to avoid paravalvular leakage; extensive decalcification should be avoided not to create annular defects. Proximal anastomoses of concomitant coronary artery bypass grafting should be placed during a single aortic cross-clamp period or alternatively with careful side clamping. Available evidence suggests that the use of sutureless and rapid deployment valve is associated with (can translate into) reduced early complications such as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions and renal replacement therapy, respectively, and may result in reduced intensive care unit and hospital stay in comparison with traditional valves. The international experts recommend various benefits of sutureless and rapid deployment technology, which may represent a helpful tool in aortic valve replacement for patients requiring a biological valve. However, further evidence will be needed to reaffirm the benefit of sutureless and rapid deployment valves.
DOI: 10.1093/ejcts/ezv369
PubMed URL: 26516193
Type: Journal Article
Subjects: Aortic valve replacement
Rapid deployment valve
Stented aortic valve prosthesis
Sutureless valve
Appears in Collections:Journal articles

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