*6.1.4.2 TAVI results*

*Aortic Stenosis - Current Perspectives*

of the thorax [32]

between the different approaches.

*6.1.3 Rapid deployment prostheses*

characteristics.

mance [37].

*6.1.2.1 Advantages and disadvantages of MIS approaches in aortic stenosis*

• reduction in the pain perceived by the patient, which results in reduced

• less respiratory complications such as atelectasis by maintaining the integrity

• better esthetic results, due to the reduced size of the surgical incisions and

• reduction on duration of hospitalization and time spent in intensive care units,

A certain consensus exists around the benefits mentioned above. There is also a question of the impact of MIS on duration of surgery. There is disparity in the results found in the literature. Once the learning curve has been overcome, these times tend to equal out, and there is no significant difference to be observed

Their use in association with MIS approaches, providing a reduction in surgical aggression in addition to the reduction in ECC and aortic clamping time. These designs have the common feature of being expandable, anchoring themselves to the aortic ring in a similar way to the devices used in TAVI. To date, there are two commercially available models: Perceval (LivaNova) and Intuity (Edwards Lifesciences). Those prostheses differ from each other in a few

• **Perceval** (LivaNova): it is useful on patients in which a reduction in surgery time may have a paramount impact, or those where it is necessary to carry out mixed procedures [35, 36]. A recent multicenter study reports a reduction on mean crossclamp and cardiopulmonary bypass times, and a significant improvement in clinical status was observed postoperatively in the majority of patients [37]. The Perceval valve implantation could be easily performed by offering a significant reduction in crossclamping and CPB times compared with both the traditional valve prostheses and the other sutureless prostheses available on the market, even when performed via a minimally invasive approach [37]. It remains important for the continuation of the patient's follow-up, in order to provide further assessment of long-term valve perfor-

• **Intuity** (Edwards Lifesciences): it is made by the conjunction between the Edwards Perimount bioprosthesis, the clinical and hemodynamic results of which are widely known, and the experience in the development of the Sapien transcatheter prosthesis. The mode of implantation for this prosthesis

Benefits have been observed in certain aspects such as:

• reduction in bleeding and use of hemoderivatives

consumption of analgesic [29–31]

their relocation to less visible areas [33]

• reduction of the surgical wound infections [34]

which results on less expensive cost of the process.

**38**

The results of the PARTNER I Cohort A trial also have important implications. The primary endpoint of the trial was met, with TAVI found not to be inferior to aortic valve replacement for all-cause mortality at 1 year. Death at 30 days was lower than expected in both arms of the trial: TAVI mortality (3.4%) was the lowest reported in any series, despite an early generation device and limited previous operator experience. Aortic valve replacement mortality (6.5%) was lower than the expected operative mortality (11.8%). On 2015, the 5-year follow-up result of the PARTNER I trial was published [44]; they screened 3105 patients, of whom 699 were enrolled (348 assigned to TAVR, 351 assigned to SAVR). At 5 years, risk of death was 67·8% in the TAVR group compared with 62.4% in the SAVR group (hazard ratio 1.04, 95% CI 0.86–1.24; p = 0.76). They recorded no structural valve deterioration requiring surgical valve replacement in either group. Moderate or severe aortic regurgitation occurred in 40 (14%) of 280 patients in the TAVR group and two (1%) of 228 in the SAVR group (p < 0.0001), and was associated with the increased 5-year risk of mortality in the TAVR group [44].
