The first experience of aortic valve replacement using a cuff with rapid deployment of mechanical and biological prosthesis-"cartridge"

• Zhurko S.A.
• Osipov A.M.
• Gamzaev A.B.
• Fedorov S.A.
• Kalinina M.L.
• Aminov K.M.
• Suhova M.B.

Abstract

Background. The use of prostheses with an attachable cuff with sutureless fixation allows to reduce aortic cross-clamp time in isolated prosthesis, as well as in concomitant coronary artery bypass grafting and other combined interventions. We present the first experience of sutureless cuff of valve implantation in aortic valve replacement.

Aim оf the study to conduct a feasibility study and evaluate the safety and efficacy of using an attachable cuff with sutureless fixation with a mechanical or biological prosthesis-cartridge.

Material and methods. Aortic valve replacement was performed in 10 consecutive patients. Access to the heart was provide by a median sternotomy incision in most cases and in one case using a mini-J sternotomy. Concomitant interventions including coronary artery bypass grafting, posterior enlargement of the small aortic annulus using the Nicks–Nunez surgical approach. The haemo-dynamic parameters of the implanted prosthesis were assessed intraoperatively using transesophageal echocardiography during the surgical intervention and up to 12 months using transthoracic echocardiography.

Results. There was no hospital mortality in the study group. Implantation of biological prosthesis - cartridge was performed in 7 patients (21 and 23 mm – 3 patients each, 25 mm – 2 patients), implantation of mechanical prosthesis – 2 patients (23 mm and 27 mm). Aortic clamp time was 46.6±9.04 min in isolated aortic valve replacement and 77.7±32.3 min in combined operations. Mean pressure gradient on the aortic valve was 8.7±4.1 mmHg in the sizes 21 mm, 7.2±3.2 mmHg in the sizes 23 mm, 6.9±2.6 mmHg in the sizes 25 mm, in the case of the biological version implantation; in the mechanical version was 4 mmHg in the sizes 25 mm, 5 mmHg in the sizes 27 mm. After 12 months, all patients who underwent aortic valve replacement using an attachable cuff with sutureless fixation are alive and asymptomatic (NYHA I).

Conclusion. The data obtained on the use of an attachable cuff with sutureless fixation using a bio-logical or mechanical prosthesis-cartridge, suggest the feasibility of this concept. In order to summarize the results, randomized, clinically controlled trials are needed to compare this technique with standard suture and transcatheter prosthesis implantation techniques. 

Keywords: aortic valve replacement; sutureless prostheses; rapid deployment valves; attachable cuff with sutureless fixation for prosthetic heart valves

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