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EDWARDS INTUITY Valve System: an innovative solution for Minimally Invasive Aortic Valve Replacement
Francesca Chiaramonti, Marco Solinas, Federica Marchi, Tommaso Gasbarri, Sergio Berti, Mattia Glauber.
Heart Hospital G. Pasquinucci, Massa, Italy.

OBJECTIVE The sutureless bioprosthesis represents an innovative approach for aortic valve replacement (AVR) reducing cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times with a faster and easier implantation. These characteristics make it especially suitable for minimally invasive approaches (MIA). We present our initial experience with a new class of rapid-deployment aortic valves, the EDWARDS INTUITY Valve System (Edwards Lifesciences LLC, Irvine, Calif) implanted in MIA. METHODS Between June 2012 and December 2013, 47 patients with symptomatic aortic stenosis underwent AVR with EDWARDS INTUITY Valve. Of these 36 patients underwent isolated AVR. In 31 (66% of all patients and 86% of isolate aortic valve disease patients) patients was performed an AVR in MIA: 21(68%) patients received an upper J-type minsternotomy and 10 (32%) patients received a right anterior minithoracotomy. Follow-up was 100% completed (mean 9 months; range 1-18 months). RESULTS Implantation success was 100% . Deployment bioprosthesis time was 15,3 ± 4,1 minutes. CPB and ACC time were 85,8 ± 17,5 and 52,2 ± 13,8 minutes respectively. These times are significantly lower then observed using sutured bioprosthesis in MIA. Mechanical ventilation time was 5,7 ± 2,4 hours, ICU stay was 1,7 ± 0,5 days and ward stay was 5,7 ± 1,4 days. The transvalvular gradient at discharge was 10,2 ± 4,1 mmHg (mean) and 16,6 ± 6,4 mmHg (peak). At three months follow up the mean transvalvular gradient was 8,3 ± 4,6 mmHg and the peak transvalvular gradient was 13,7 ± 7,2 mmHg. There were no deaths. CONCLUSIONS Minimally invasive AVR using an EDWARDS INTUITY Valve is a feasible and reproducible procedure with excellent results in terms of survival and hemodynamic performance at short term follow up. This bioprosthesis represent a useful tool that promise to reduce technical difficulties and operative times during AVR in MIA. Future evolutions of this device may performed a simpler and more easily reproducible implantation procedure, increasing the spreding of this approach. However, experience with a larger series of patients and a longer follow up are necessary to validate these preliminary data.

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