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A new technique that prevents paravalvular leakage after aortic valve replacement using a rapid‐deployment valve system
Author(s) -
Yamamoto Taira,
Endo Daisuke,
Yamaoka Hironobu,
Matsushita Satoshi,
Kajimoto Kan,
Asai Tohru,
Amano Atsushi
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15513
Subject(s) - medicine , cardiac skeleton , aortic valve replacement , commissure , surgery , aortic valve , mechanical valve , cardiology , stenosis , anatomy
Background We report our 1‐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 1‐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 three‐dimensional computed tomography were larger and more accurate than those measured using ultrasonic echocardiography. Postoperative RD‐AVR prosthetic valve function was excellent. However, PVL occurred in four cases 1 week and 1 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.