A new technique that prevents paravalvular leakage after aortic valve
replacement using a rapid deployment valve system
Abstract
Background and aim of the study: We report our one-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 one-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 3-dimensional
computed tomography (3D-CT) were larger and more accurate than those
measured using ultrasonic echocardiography Postoperative RD-AVR
prosthetic valve function was excellent. However, PVL occurred in 4
cases one week and one 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.