Rapid Deployment Biological Aortic Valve Replacement in Redo Operations: A Retrospective Real-Word Experience Report of Clinical and Echocardiographic Outcomes

Objective: This retrospective study aimed to compare the outcomes of rapid deployment aortic valve replacement (rdAVR) and conventional bioprosthetic sutured AVR (cAVR) in high-risk patients undergoing redo surgery. Methods: A total of 79 patients who underwent redo AVR between 2014 and 2021 were included in the study. Of these, 27 patients underwent rdAVR and 52 underwent cAVR. Patient characteristics and clinical outcomes were analysed using multivariate regression and Cox-survival analysis. Results: The groups were similar in terms of age, gender, left ventricular function, and number of previous sternotomies. In cases of isolated AVR, rdAVR had significantly lower cross clamp times than cAVR (71 vs. 86 minutes, p = 0.03). Postoperatively, 4 cAVR patients required pacemaker compared to zero patients in the rdAVR group. There were no significant differences between the two groups in terms of postoperative complications, intrahospital stay (median 9 days, IQR 7–20), or in-hospital mortality (1 rdAVR; 2 cAVR). The long-term survival rate was similar between the rdAVR (90%) and cAVR (92%) groups (log rank p = 0.8). The transvalvular gradients at follow-up were not affected by the type of valve used, regardless of the valve size (coef 2.68, 95%CI -3.14-8.50, p = 0.36). Conclusion: The study suggests that rdAVR is a feasible and safe alternative to cAVR in high-risk patients undergoing redo surgery. The use of rdAVR offers comparable outcomes to cAVR, with reduced cross clamp times and a lower incidence of postoperative pacemaker requirement in isolated AVR cases. The