The Use of Sutureless and Rapid-Deployment Aortic Valve Prosthesis in Patients with Bicuspid Aortic Valve: A Focused Review

The use of sutureless and rapid-deployment prostheses is generally avoided in patients with BAV due to anatomical concerns and the elevated risk of para-prosthetic leaks. Multiple studies have reported the use of these prostheses in patients with BAV with varying degrees of success. The focus of this review is to consolidate the available evidence on this topic. A scoping review was conducted using a comprehensive search strategy within Medline, Embase, and Cochrane Central Register of Controlled Clinical Trials for relevant articles. All abstracts and full texts were screened by two independent reviewers according to predefined inclusion and exclusion criteria. Of 1052 total citations, 44 underwent full text review and 13 (4 case reports, 6 retrospective analyses, and 3 prospective analyses) were included in the scoping review. Across all 13 studies, a total of 314 patients with BAV were used for data analysis. In sutureless and rapid-deployment prostheses, the mean postoperative aortic valvular gradients were less than 15mmHg in all studies with mean postoperative aortic valvular areas all greater than 1.3cm. There were 186 total complications for an overall rate of 59%. Individual complications included new onset atrial fibrillation (n=65), required pacemaker insertion (n=24), intraprosthetic aortic regurgitation (n=20), new onset atrioventricular block (n=18), and new onset paravalvular leakage (n=10). The use of sutureless and rapid deployment prostheses in patients with BAV showed comparable intraoperative and implantation success rates to patients without BAV. Various techniques have been described to minimize complications in patients with BAV receiving sutureless or rapid-deployment prostheses.