Minimally invasive redo aortic valve replacement: results from a multicentric registry (SURD-IR)

Abstract Background Reoperation for aortic valve replacement (AVR) can be challenging and is usually associated with an increased risk for complications and mortality. The study aim was to report the results of a multicenter cohort of patients who underwent minimally invasive reoperative AVR with a sutureless or rapid-deployment prosthesis. Methods From 2007 to 2018, a total of 3651 patients were retrospectively collected from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR). Out of them, 63 patients who had previously undergone cardiac surgery represented the study population. In-hospital clinical and echocardiographic outcomes were recorded. Results Mean age of the selected 63 patients was 75.3±7.8 years and logistic EuroSCORE 10.1. Surgery was performed via ministernotomy in 43 patients (68.3%) and via anterior right thoracotomy in 20 (31.7%); 31 patients (49.2%) received the Perceval valve and 32 (50.8%) the Intuity valve. Mean cross-clamp time was 57.8±23.2 min and cardiopulmonary bypass time was 95.0±34.3 min. Neither conversion to full sternotomy nor in-hospital deaths occurred. Postoperative events were ischemic cerebral events in 3 (4.8%) patients, need for pacemaker implantation in 2 (3.6%), bleeding requiring reoperation in 5 (8.9%), and dialysis in 1 (1.6%). Median intensive care unit stay was 1 day, median length of hospital stay was 10 days. On echocardiographic evaluation, one patient showed a significant postoperative aortic regurgitation. Conclusions Minimally invasive reoperative AVR with a sutureless or rapid-deployment prosthesis is a safe and feasible treatment strategy, resulting in fast recovery and improved postoperative outcome with no mortality and an acceptable complication rate.