Standard Versus Rapid-Deployment Aortic Valve Replacement and Concomitant Myocardial Revascularization: 5-year Bi-Center Clinical Outcomes.

OBJECTIVES: Clinical outcomes of two generations of pericardial bioprostheses in concomitant aortic valve and coronary artery bypass graft surgery were analyzed.

METHODS: Patients were recruited from two European centers and divided into 2 groups based on the type of aortic bioprosthesis used: Edwards Intuity EliteTM rapid deployment bioprostheses or standard Edwards Magna Ease (Edwards Lifesciences, Corporation, Irvine, California, US). A propensity score weighting approach was used for data analysis.

RESULTS: 285 patients were included: 144 (50.5%) in the Rapid Deployment group and 141 (49.5%) in the Magna Ease group. Thirty-day mortality was 2.8% (Rapid Deployment) and 5% (Magna Ease) (P = 0.089). Significantly shorter times of aortic cross-clamp and cardiopulmonary bypass were observed in the Rapid Deployment cohort [94 vs 120 min; (P < 0.001); 128 vs 160 min (P < 0.001)]. The Rapid Deployment group was associated with a lower median transvalvular gradient at discharge and follow-up (both P < 0.001). However, 5-year survival was not different, being 93% in Rapid Deployment patients and 91% in the Magna Ease group [HR 0.89 (CI 95%:0.38-2.09), P = 0.784]. The 5-year cumulative incidence of combined events (including percutaneous coronary interventions, endocarditis, thromboembolic events, rehospitalizations, and bleeding) favored the Magna Ease group [16.1% (Rapid Deployment) vs 7.3% (Magna Ease), [HR 2.38 (CI 95%:1.03-5.52), P = 0.043]. However, this turned similar when the Cox model analysis was adjusted for revascularization variables (P = 0.067).

CONCLUSIONS: Rapid deployment and Magna Ease pericardial bioprostheses used in concomitant aortic valve replacement and coronary artery revascularization provide equivalent clinical and haemodynamic 5-year outcomes, despite constant lower transvalvular gradients and shorter surgical operating times observed with rapid deployment technology.