Intuity Elite Rapid Deployment Aortic Valve Replacement: Lessons From 8 Years of Experience

The lessons learned from 8 years of experience using the Intuity Rapid Deployment valve is summarized. The first patient underwent resternotomy Aortic Valve Replacement (AVR) and concomitant Mitral and Tricuspid annuloplasty. This case demonstrates the expeditious implant of a 25mm Intuity Elite valve. A step-by-step description of the procedure is shown. The annular skirt was balloon expanded after implantation of a rigid mitral annuloplasty ring. This did not cause atrio-ventricular conduction disturbances, and there was no paravalvular leak on TEE. The second case is of an octogenarian undergoing AVR with concomitant coronary artery bypass graftings of her right and left anterior descending coronaries. This case highlights the possibility for significant paravalvular leaks, due to inadvertant distortion of the commissure during prosthesis seating. In particular the Non-coronary and Left-coronary cusp (NCC-LCC) commissure was displaced below th e annular plane by the 19mm Intuity Elite valve and delivery system, during passage through the small aorta. This was promptly identified after balloon dilatation of the annular skirt. However once deployed, the prosthesis cannot be adjusted and was subsequently removed. A new 19mm Intuity Elite was successfully implanted, after placing further commissural sutures for counter-traction. In this patient, the NCC-LCC suture was also tied onto the prosthesis. The patient subsequently did well and did not have any paravalvular leak on TEE. An original thoracoscopic view of the left ventricular outflow tract seen through the first generation Intuity delivery shaft shows: (1) the proximity of the annular skirt to the anterior mitral leaflet, and (2) the reassuring absence of the aortic annulus below the prosthesis. The Intuity Elite valve may facilitate expeditious surgery, but care and attention remains essential to avoid the pitfalls shown that may lead to less than satisfactory out comes.

Reference

1. Kocher AA, Laufer G, Haverich A et al. One year outcomes of the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the Edwards INTUITY Valve System. J Thorac Cardiovasc Surgery. 2013 Jan;145(1):110-5.

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