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You are here: Contents > 2012 > Volume 21 Number 6 November 2012 > AORTIC VALVE DISEASE > Aortic Cross-Clamp Time, New Prostheses, and Outcome in Aortic Valve Replacement

Aortic Cross-Clamp Time, New Prostheses, and Outcome in Aortic Valve Replacement

Marco Ranucci, Alessandro Frigiola, Lorenzo Menicanti, Serenella Castelvecchio, Carlo de Vincentiis, Valeria Pistuddi, for the Surgical and Clinical Outcome Research (SCORE) Group
Departments of Cardiothoracic and Vascular Anesthesia and Intensive Care and Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy

Background and aim of the study: A number of sutureless bioprosthetic aortic valves have been recently introduced in clinical practice, their main advantage being a reduction in the aortic cross-clamp time (AXCT). The study aim was to investigate if AXCT was a determinant of cardiovascular morbidity in patients undergoing surgical aortic valve replacement (AVR) to treat aortic valve stenosis, and to identify any subset of patients who might benefit from a reduction in AXCT.
Methods: A retrospective analysis was conducted of 979 consecutive patients with aortic valve stenosis who underwent surgical AVR. The AXCT was analyzed as an independent predictor of severe cardiovascular morbidity, defined as the presence of a low cardiac output, stroke, acute kidney injury, or

operative mortality. Subgroups of patients who benefited more from a reduction in AXCT were investigated.
Results: The AXCT was an independent predictor of severe cardiovascular morbidity, with an increased risk of 1.4% per 1 min increase. Patients with a left ventricular ejection fraction ≤40%, and also diabetic patients, showed the most relevant clinical benefits induced by a reduction in AXCT.
Conclusion: In selected patient populations at high risk of systolic dysfunction, the use of sutureless aortic valve bioprostheses may be considered. However, the routine use of such bioprostheses should be pondered within a cost-benefit analysis.

The Journal of Heart Valve Disease 2012;21:732-739

Aortic Cross-Clamp Time, New Prostheses, and Outcome in Aortic Valve Replacement

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