Use of Rapid Deployment Bioprosthesis in Bicuspid and Tricuspid Aortic Valve Pathology: 8-year Single Center Experience in 383 Patients.

Purpose: Rapid deployment bioprostheses (RDBP) enable faster valve implantation in surgical aortic valve replacement (SAVR), but are associated with increased risk of pacemaker implantation and can be challenging to implant in pure bicuspid aortic valves (BAV). We aimed to evaluate the outcome of RDBP in bicuspid and tricuspid aortic valve pathology.

Methods: Between May 2015 and May 2023, all consecutive patients who underwent an isolated or combined SAVR procedure with the use of an RDBP in our center were retrospectively included. Early and late outcome including mortality and reinterventions were assessed.

Results: A total of 383 patients with a mean age of 72 ± 6 years (55% male) who underwent SAVR with the use of an RDBP were included in this study. Overall survival was 89% at 8 years. Minimally invasive SAVR was associated with significantly lower in-hospital mortality (p=0.011), while there was no difference in overall survival up to 8 years (p=0.838). 12 patients (3%) had to undergo a reintervention of the aortic valve (9 (75%) for PVL closure, 2 (17%) for endocarditis and 1 (9%) for structural valve deterioration respectively), of whom 8 patients (67%) had a bicuspid aortic valve (BAV) (p=0.008). Significantly less patient prosthesis mismatch (PPM) occurred in patients with BAV compared to patients with a tricuspid aortic valve (p < 0.001). Type of BAV did not influence the incidence PPM (p=0.907). Both calculated moderate and severe PPM did not influence survival (p=0.834 and p=0.414 respectively) and neither did small valve size (p=0.751). Permanent pacemaker implantation occurred overall in 8.4%, but was not influenced by the presence of BAV (p=0.847).

Conclusion: The use of an RDBP in SAVR is associated with excellent long-term survival and freedom from reinterventions. It especially facilitates minimally invasive SAVR approaches, without compromising early risk or late outcome. Although BAV pathology is a risk factor for reintervention, it is also associated with less PPM and equal risk of permanent pacemaker implantation.

Identify the source of the funding for this research project: No funding was received for to this research project.