Promising early outcomes in surgical aortic valve replacement utilizing the rapid deployment approach for isolated aortic valve regurgitation

OBJECTIVES: Surgical aortic valve implantation remains the therapeutic gold standard for aortic valve regurgitation. Due to annular dilatation and lack of calcification, transcatheter aortic valve replacement is not recommended. Although rapid deployment valves allow faster implantation and excellent haemodynamics, they are currently not recommended for patients with aortic valve regurgitation. This study retrospectively analysed the use of rapid deployment prostheses in patients with pure aortic valve regurgitation. METHODS: From 2014 to 2022, 444 rapid deployment valves were implanted. Since 2017 until 2022, 22 were used for patients with pure aortic valve regurgitation. This cohort was compared to 77 patients who had undergone rapid deployment valve implantation for pure aortic stenosis during the same time period. Both cohorts were analysed for major clinical outcomes, including pacemaker implantation, mortality, major adverse cardiovascular and cerebrovascular events (MACCE), and the need for redo surgery. RESULTS: In both groups, no valve intraoperative and postoperative valve revisions were required. Transvalvular gradients were comparable between the groups (ΔPmean/max 7.1/13.3 mmHg in the aortic valve regurgitation and 7.9/14.7 mmHg in the AS cohort), and there were no paravalvular leaks. The postoperative pacemaker implantation rate was 0% for the rapid deployment group and 1.3% for the conventional valve replacement group. CONCLUSIONS: These results suggest that rapid deployment valves can be safely applied for the treatment of patients with aortic valve regurgitation, even in the absence of calcification. This expands the surgeon's armamentarium and can be especially useful in patients requiring extensive surgery where saving aortic cross-clamp time may be especially beneficial.