An update in aortic valve replacement without sternotomy
One of Harefield Hospital's leading consultant surgeons, Mr Toufan Bahrami, discusses the latest developments in aortic valve replacement.
The techniques of aortic valve replacement are rapidly evolving, with multiple approaches and valve options available. At Harefield Hospital, great success has been seen with the newer generation Edwards INTUITY-Elite® valve, which is a balloon-expandable stented trileaflet bovine pericardial bioprosthesis (magna ease with known excellent durability of up to 15 years).
This new valve offers a number of key benefits and when coupled with the technique of surgical implantation through a mini-thoracotomy or mini-sternotomy approach, it provides patients with some key advantages.
‘Sutureless’ or rapid-deployment (RD) aortic valve replacement (AVR) is an alternative to standard surgical AVR performed through breast bone incision or transcatheter aortic valve implantation (TAVI).
Traditionally, high-risk and inoperable patients would be considered for the less invasive TAVI procedure. The progression in minimally invasive surgical techniques is now allowing some of these patients to access the benefits of AVR to treat aortic stenosis.
Edwards INTUITY-Elite® valve
As of 2016, 63 of the newer generation Edwards INTUITY-Elite® valves have been implanted at Harefield Hospital, and more than 80 per cent of these implantations have been performed through right mini-thoracotomy using a 6 to 7 cm incision. The results so far show zero per cent rate of stroke, no leakage around the valve and zero per cent death rate.
The implantation technique using the INTUITY-Elite® remains independent of the surgical approach chosen by the surgeon; however, 90 per cent of Mr Toufan Bahrami's first-time heart patients that are deemed suitable for this procedure are opting for mini-thoracotomy as it provides some key advantages.
Key benefits of sutureless AVR via mini-thoracotomy compared routine surgical AVR include:
- a reduction in controlled cardiac arrest time (up to 30 minutes)
- a reduction in cardiopulmonary bypass time (up to 40 minutes)
- reduced scaring by avoiding the opening of the breast bone
- reduced infection and faster recovery time
- earlier patient discharge and faster return to routine activities such as driving or work (two weeks vs. six weeks).
Consultant cardiac surgeon