Supra-annular aortic valve replacement: technique and early outcomes

OBJECTIVES: The supra-annular aortic valve replacement (SA-AVR) allows for implantation of larger prostheses. We describe the technique, early post-operative outcomes and hospital mortality. METHODS: Patients who underwent SA-AVR with the Carpentier-Edwards Magna Ease bioprosthesis between December 2010 and December 2017 were retrospectively reviewed. The prosthesis was sutured to the aortic annulus along the coronary sinuses, and in a supra-annular position along the non-coronary sinus. RESULTS: 115 patients were included (mean age: 71,6 years ± 9,4). Mean bioprosthesis diameter was 23,3 ± 1,7 mm. Four early deaths were observed in the ICU. Early post-operative complications included: re-operation for bleeding (n=6), tamponade (n=7), permanent atrioventricular block (n=4) and hemodialysis (n=2). In-hospital mortality was 3,48%. Postoperative echocardiography showed a marked decrease in the mean left ventricle – aorta gradient (50,4 ± 16,1 mmHg vs 11,3 ± 4,05 mmHg). CONCLUSION: SA-AVR is safe and associated with favourable immediate outcomes in patients with small aortic annulus.