Intraoperative Parameters
Minimally invasive surgical approaches to implant sutureless and rapid
deployment prostheses were used in most studies. Cardiopulmonary bypass
times and cross-clamp times are consistent with sutureless and
rapid-deployment valve replacement techniques in patients without
BAV.16, 24 However, in studies including non-BAV
patients treated with sutureless16 or
rapid-deployment24 valve replacement compared to
conventional valve replacement, the hypothesized benefit of reduced CBP
and cross-clamp times on postoperative mortality was not statistically
significant. Across studies reporting complications specifically for
patients with BAV, 1 case involving sutureless (Perceval) implantation
failed and required a sutured valve to be
substituted.18 In an additional 5 BAV patients treated
with sutureless (Perceval) prostheses11, 14, 17, 22redeployment was necessary for correct positioning. Although Tsai et
al22 reported redeployment in 2 out of 5 patients
treated with sutureless prostheses, they reported increased success with
subsequent surgeries as additional techniques for valve implantation
were utilized. Of note, no redeployment was reported from any studies
using Edwards Intuity rapid deployment valves in BAV patients. For
studies that did not specify between patients with and without BAV, Suri
et al20 reported a 96.3% success rate for deployment
of sutureless (Perceval) prostheses in 300 patients and Szecel et
al21 reported 2 cases (0.4%) where a standard stented
valve was substituted due to failure of effective sutureless (Perceval)
valve implantation. These intraoperative findings suggest that
implanting sutureless and rapid deployment prostheses in BAV patients
has a low incidence of failure requiring conversion to sutured valves or
redeployment, with comparable implantation success to patients without
BAV.20, 21