Mitral Valve Surgery in Combination with Rapid Deployment Aortic Valve Replacement

MP040 

Abstract Submission 

Harald Dr.Hausmann (1), Alaa Maali (1), Adrian Bauer (1), Jens Schubel (2)

(1) MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, (2) Mediclin Herzzentrum Coswig, Coswig, Sachsen Anhalt

Harald Dr.Hausmann    -  Contact Me
MediClin Heart Center Coswig

Alaa Maali    -  Contact Me
MediClin Heart Center Coswig

Adrian Bauer    -  Contact Me
MediClin Heart Center Coswig

Jens Schubel    -  Contact Me
Mediclin Herzzentrum Coswig

Harald Dr.Hausmann    -  Contact Me
MediClin Heart Center Coswig

Objective: Rapid deployment valve prostheses (RDV) have been used more and more frequently in aortic valve surgery in recent years due to the simplicity and speed of implantation. It is still unclear whether technical problems such as leaks occur in combination with operations on the mitral valve and whether advantages can be achieved in the combined operations when using RDV in the aortic position.
Methods: From 2019 to 2022 we performed 105 combination surgeries of mitral - and aortic valve surgery. The STS score in all patients was calculated to a mean of 3.9 +/- 1.7. We implanted a RDV in 42 cases in the aortic position (group A). Sixty-three patients received mitral valve surgery in combination with a conventional aortic valve replacement (group B). All patients underwent intraoperative control echocardiography (TEE). In addition, a transthoracic echocardiography was performed before discharge and after 1 year postoperatively. Propensity score matching resulted in 41 matching pairs, which were analyzed.
Results: In group A the intraoperative mortality was 2.4% and in group B 4.9% (p>0.05). One patient of group A, suffered from a significant paravalvular leak at the aortic prosthesis intraoperatively, so we revised the implantation with a conventional valve prosthesis. The operating time (255 +/- 45 min vs. 283 +/- 51 min) and the cross clamp time (91 +/- 21 min vs. 115 +/- 35 min) were significantly lower in group A than in group B. In group A, the transvalvular mean pressure gradient with 9.0 +/- 5.1 of the aortic prosthesis was significantly lower than in group B with 16.5+/- 6.7mmHg. The time spent in the intensive care unit and the time spent in hospital did not differ between the two groups. After 1 year, survival rates were in group A 92.6% and in group B 89.9%. We noticed no differences in either group with regard to mitral valve function. There were no paravalvular leaks from the prosthetic mitral valves or a higher failure rate of the reconstructed mitral valves.
Conclusions: Technically, there is no problem using an RDV in mitral valve operations where the aortic valve also needs to be replaced. The operative and early postoperative results are comparable. It is noticeable that the RDV show a lower pressure gradient. Long-term courses must show whether there is also a clinical advantage for the patient. With regard to the function of the mitral valve, there are no problems when inserting the RDV in combined mitral surgery.

Degenerative Valve Disease