The Use of Sutureless and Rapid-Deployment Aortic Valve Prosthesis in
Patients with Bicuspid Aortic Valve: A Focused Review
Abstract
The use of sutureless and rapid-deployment prostheses is generally
avoided in patients with BAV due to anatomical concerns and the elevated
risk of para-prosthetic leaks. Multiple studies have reported the use of
these prostheses in patients with BAV with varying degrees of success.
The focus of this review is to consolidate the available evidence on
this topic. A scoping review was conducted using a comprehensive search
strategy within Medline, Embase, and Cochrane Central Register of
Controlled Clinical Trials for relevant articles. All abstracts and full
texts were screened by two independent reviewers according to predefined
inclusion and exclusion criteria. Of 1052 total citations, 44 underwent
full text review and 13 (4 case reports, 6 retrospective analyses, and 3
prospective analyses) were included in the scoping review. Across all 13
studies, a total of 314 patients with BAV were used for data analysis.
In sutureless and rapid-deployment prostheses, the mean postoperative
aortic valvular gradients were less than 15mmHg in all studies with mean
postoperative aortic valvular areas all greater than 1.3cm. There were
186 total complications for an overall rate of 59%. Individual
complications included new onset atrial fibrillation (n=65), required
pacemaker insertion (n=24), intraprosthetic aortic regurgitation (n=20),
new onset atrioventricular block (n=18), and new onset paravalvular
leakage (n=10). The use of sutureless and rapid deployment prostheses in
patients with BAV showed comparable intraoperative and implantation
success rates to patients without BAV. Various techniques have been
described to minimize complications in patients with BAV receiving
sutureless or rapid-deployment prostheses.