Redo aortic valve replacement:

the sutureless approach

G. Santarpino*, S. Pfeiffer, G. Concistré, T. J. FischleinKlinikum Nürnberg - Cardiovascular Center, Nuremberg, Germany

* No conflict of interest

There are many questions with more than one answer in cardiac surgery…

Without debate, there would be no progress!

Redos

We are looking for new ideas to keep it simple and safe

CAVALIER TRIAL – update at December 15, 2011

558 patients

(from Feb 2010)

83 pts. in

Nuremberg

13 pts. in Redos

(15,7%)

Redos - Preoperative data

Pts n. 13

Age mean 75,2 ± 5,6 min 67 max 86Age mean 75,2 ± 5,6 min 67 max 86

Log Euroscore 19,4±10,7 min 8,5 max 47,5

male/female 6/7 (46/54%)

First operation: CABG in 7

AVR in 5

AVR+CABG in 1

Intraoperative data

21 mm

1 pts (8%)

25 mm

5 pts (38%)

23 mm

7 pts (54%)

5 pts (38%)

Associated procedure 2 (15,4%) 1 Re-CABG

1 TV-annuloplasty

Intraoperative data

Stentless Solo 23 mm > Perceval 23

Stentless Freedom 25 mm > Perceval 21

Stentless Freedom 27 mm > Perceval 23

Stentless Shelhigh 25 mm > Perceval 23

=

Stentless Shelhigh 25 mm > Perceval 23

Stented Soprano 18 mm > Perceval 23

Stented Mitroflow 21 mm > Perceval 23

Intraoperative data

CPB 79±23 min

X-clamp 44±16 minX-clamp 44±16 min

Implant 8±2,3 min

No associated procedure and first OP CABG or first OP stentless (9 pts) 27

min DS????

Intraoperative data

1 CABG lesion

1 intraoperative explant

Postoperative data

No migration

No thrombosis

ICU 3,2±2,2

Hospital 12,1±4,4

No exitus

1 pacemaker (7,7%)

1 TIA (7,7%)

1 Transient renal failure (UF) (7,7%)

Follow up 8,5 months (up to 15 months)

Freedom from reoperation and/or endocarditis 100%

no exitus

no events

Preop (13 pts) Postop (13 pts) 6 months (11 pts) 1 year (5 pts)

max mn max mn max mn max Mn

85±19 48±13,5 26,7±9 14,3±4,9 24,9±4,4 12,7±6,5 21,7±5 12,1±4,4

90

100mmHg

Gradients

0

10

20

30

40

50

60

70

80

90

preop postop 6 months 1 year

Gr max

Gr mn

1 1 0

0 0 0

Aortic insufficiency

Valvular regurgitation

Trivial

Mild

At discharge 6 mo 12 mo

(n=13) (n=11) (n=5)

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

Mild

Moderate

Paravalvular regurgitation

Trivial

Mild

Moderate

Is safe, fast and easy, requiring only a short learning curve

Conclusion

Ensures excellent haemodynamic performance

Allows X-clamp time reduction

Is a step forward for redo procedures

Nuremberg - Germany

Thank you! Danke! Grazie!