J-sternotomy AVR: Standard Versus Rapid Deploymant Aortic Valve Bioprostheses

Objective: Our aim was to compare the clinical and echocardiographic outcomes between patients who received standard sutured bioprosthesis to those who underwent rapid-deployment bioprosthesis implantation, both through a J-sternotomy approach.

Methods: Since 2014, 170 consecutive patients underwent isolated AVR through J-sternotomy. Of them, 109 patients underwent rapid deployment (RD) implantation and 61 patients received a standard sutured bioprosthesis (STD). The two groups were compared for early and midterm clinical and echocardiographic outcomes.

Results: In the RD group patients where significantly older 73±10 years compared to 64±12 in the STD group (p=0.01) and had significantly higher prevalence of females (62% vs 30%, p=0.01). Otherwise There were no significant differences in comorbidities, mean NYHA score, or echocardiographic features between the two groups. The mean Bypass times (66±20 min vs 78±16, p=0.01) and mean cross clamp times (45±13 min vs 60±13, p=0.01) were shorter in the RD group. There was one early mortality in the RD group and non in the STD (p=1.0), and there was no difference in other major early complications (CVA, TIA, Dialysis, IABP) between the groups. 10 patients (9%) in the RD group required permanent pacemaker implantation vs non in the STD group (p=0.015). However, In the last year after changing the implantation techniques of the RD implantation no patient required a pacemaker.

At mid-term follow-up (15±17 months) there were no significant differences in late death (5% vs 4%, p=0.3), functional class, EF (58±10% vs 61±4%, p=0.3) or trans- aortic mean peak gradients (22±12 vs 21±8, p=0.4) in the RD and the STD group respectively

Conclusions: In general, both RD and STD bioprosthesis implantation via J-sternotomy provide similar outcomes. In RD bioprosthesis implantation particular surgical technique measures should be used for the reduction in the need for post-operative permanent pacemaker