It's not just the CROWN that makes the king, results in aortic position

• Published in: Cirugía cardiovascular 2024-09, Vol.31 (5), p.200-206
• Main Authors: German J. Chaud, Joaquín Gundelach, Marcos Durand, Jaime Horta, Rodrigo Gomez, Ignacio Cuadra, Sintya Provoste, Yelka Tenelema, Cristóbal Alvarado, Gustavo Meriño
• Format: Article
• Language: Spanish
• Subjects: Mínimamente invasivo; Reemplazo de válvula aórtica; Valve in valve; Válvula bioprotésica
• ISSN: 1134-0096

Introduction: The use of biological valves in the aortic position has become more liberal in recent years due to improvements in prostheses and the possibility of performing valve-in-valve procedures, thus avoiding anticoagulation. Methods: We retrospectively evaluated 246 adults in whom the Crown PRTTM biological valve was used in the aortic position, including elective and emergency cases, isolated and combined surgeries (CS). We also evaluated mortality at 1, 3, and 5 years of follow-up. Results: In this study, CS involved 94 patients (38%), while 39 patients (16%) underwent urgent or emergency procedures, which included cases of aortic dissection and endocarditis. Approximately 69% of the patients received a valve more significant than 21 mm. A minimally invasive surgical approach was employed in 42 patients (17%). The in-hospital mortality for the entire patient population was 3.6% (n = 9), with isolated aortic valve replacement (AVR) accounting for 3.3% (n = 5) and CS for another 4.3% (n = 4). The mortality for isolated AVR and CS in elective situations was n = 2 (1.3%) and n = 1 (1.1%), respectively. During the follow-up period, only seven patients required reoperation, with two patients (0.8%) experiencing structural valve deterioration and five other patients (2.1%) requiring reoperation due to prosthetic valve endocarditis. Conclusion: The use of the Crown valve in the aortic position appears to be safe regarding postoperative morbidity and mortality. Further studies are necessary to assess its applicability in younger patients and predict its performance in the event of a valve-in-valve procedure. Resumen: Introducción: El uso liberal de válvulas biológicas en posición aórtica en los últimos años se debe a la posibilidad de evitar la anticoagulación, a mejoras en las prótesis y la posibilidad de realizar procedimientos de ViV, por sus siglas en inglés, ante futuras reintervenciones. Métodos: Evaluamos retrospectivamente a 246 adultos en quienes se utilizó la válvula biológica Crown PRTTM en la posición aórtica, incluyendo casos electivos y de emergencia, así como cirugías aisladas y combinadas (CC). También evaluamos la mortalidad a 1, 3 y 5 años de seguimiento. Resultados: Noventa y cuatro pacientes (38%) recibieron CC, mientras que 39 pacientes (16%) se sometieron a procedimientos urgentes o de emergencia, que incluyeron casos de disección aórtica y endocarditis. En el 69% se implantó una válvula de más de 21 mm. Se empleó cirugía mínimamente