Hemodynamic Comparison of Sutureless and Rapid-Deployment Valves with Conventional Bioprostheses.

ABSTRACT

BACKGROUND: Sutureless and rapid-deployment bioprostheses (RPDs) are advantageous due to shorter aortic cross-clamp times (ACCs); however, few studies have investigated hemodynamic outcomes in comparison to conventional bioprostheses (CBs). METHODS: All patients receiving the Perceval (LivaNova, London, United Kingdom) and Intuity (Edwards Lifesciences, Irvine, California, United States) valves from February 2016 to December 2017 were included (n = 61). For controls, patients who underwent aortic valve replacement using CB from 2015 to 2018 (n = 743) were propensity-matched (n = 108). Primary end points were mean gradient at discharge, true internal diameter (ID) after implantation, and paravalvular leakage. Secondary end points were ACCs, cardiopulmonary bypass times (CPBTs), mortality, and pacemaker implantation. RESULTS: Age was 73.2 years (standard deviation [SD] 7.6) in the RPD group and 72.9 years (SD 7.3) in the CB group (p = 0.827). Median logistic EuroSCORE II was 3.4% (Q1 2; IQ3 5.3) and 3% (Q1 1.9; IQ3 5.6; p = 0.599). While ACCs and CPBT were shorter in RPDs (97 [SD 31.4] vs. 125.4 minutes [SD 62.1], p = 0.003; and 76.1 [SD 25.7] vs. 89.7 minutes [SD 34.3], p = 0.022), procedural times were similar (p = 0.257). True ID was 21.97 mm (SD 1.79) in RPDs and 20.15 mm (SD 1.70) in CB (p < 0.001).RPDs and CB resulted in comparable mean gradients (12.8 mm Hg [SD 6.4] vs. 13.8 mm Hg [SD 5.6]; p = 0.387) and rate of paravalvular regurgitation. There were no differences in the rates of pacemaker implantation and mortality.In a subanalysis of RPDs, mean gradient was 15.48 mm Hg (SD 7.51) in Perceval (n = 21) and 10.79 mm Hg (SD 4.78) in Intuity (n = 33; p = 0.010). CONCLUSIONS: RPDs provided comparable hemodynamic performance, although implanted valves were larger in true ID. Whether this provides superior hemodynamic performance during exercise and longer durability needs further investigation. Among RPDs, the Intuity valve provided lower mean gradients at rest than Perceval valve.