Intraoperative Parameters
Minimally invasive surgical approaches to implant sutureless and rapid deployment prostheses were used in most studies. Cardiopulmonary bypass times and cross-clamp times are consistent with sutureless and rapid-deployment valve replacement techniques in patients without BAV.16, 24 However, in studies including non-BAV patients treated with sutureless16 or rapid-deployment24 valve replacement compared to conventional valve replacement, the hypothesized benefit of reduced CBP and cross-clamp times on postoperative mortality was not statistically significant. Across studies reporting complications specifically for patients with BAV, 1 case involving sutureless (Perceval) implantation failed and required a sutured valve to be substituted.18 In an additional 5 BAV patients treated with sutureless (Perceval) prostheses11, 14, 17, 22redeployment was necessary for correct positioning. Although Tsai et al22 reported redeployment in 2 out of 5 patients treated with sutureless prostheses, they reported increased success with subsequent surgeries as additional techniques for valve implantation were utilized. Of note, no redeployment was reported from any studies using Edwards Intuity rapid deployment valves in BAV patients. For studies that did not specify between patients with and without BAV, Suri et al20 reported a 96.3% success rate for deployment of sutureless (Perceval) prostheses in 300 patients and Szecel et al21 reported 2 cases (0.4%) where a standard stented valve was substituted due to failure of effective sutureless (Perceval) valve implantation. These intraoperative findings suggest that implanting sutureless and rapid deployment prostheses in BAV patients has a low incidence of failure requiring conversion to sutured valves or redeployment, with comparable implantation success to patients without BAV.20, 21