Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Gersak, B; Fischlein, T; Folliguet, TA; Meuris, B; Teoh, KH; Moten, SC; Solinas, M; Miceli, A; Oberwalder, PJ; Rambaldini, M; Bhatnagar, G; Borger, MA; Bouchard, D; Bouchot, O; Clark, SC; Dapunt, OE; Ferrarini, M; Laufer, G; Mignosa, C; Millner, R; Noirhomme, P; Pfeiffer, S; Ruyra-Baliarda, X; Shrestha, M; Suri, RM; Troise, G; Diegeler, A; Laborde, F; Laskar, M; Najm, HK; Glauber, M.
Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel.
EUR J CARDIO-THORAC. 2016; 49(3): 709-718.
Doi: 10.1093/ejcts/ezv369
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- Co-Autor*innen der Med Uni Graz
- Dapunt Otto Eugen
- Oberwalder Peter
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- 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. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
- Find related publications in this database (using NLM MeSH Indexing)
- Aortic Valve - surgery
- Bioprosthesis -
- Consensus -
- Heart Valve Prosthesis -
- Heart Valve Prosthesis Implantation - instrumentation
- Heart Valve Prosthesis Implantation - methods
- Humans -
- Stents -
- Find related publications in this database (Keywords)
- Aortic valve replacement
- Sutureless valve
- Rapid deployment valve
- Stented aortic valve prosthesis
- Recommendations