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Ali-Hasan-Al-Saegh S, Takemoto S, Shafiei S, Yavuz S, Arjomandi Rad A, Amanov L, Merzah AS, Salman J, Ius F, Kaufeld T, Schmack B, Popov AF, Sabashnikov A, Ruhparwar A, Zubarevich A, Weymann A. Sutureless Aortic Valve Replacement with Perceval Bioprosthesis Superior to Transcatheter Aortic Valve Implantation: A Promising Option for the Gray-Zone of Aortic Valve Replacement Procedures-A State-of-the-Art Systematic Review, Meta-Analysis, and Future Directions. J Clin Med 2024; 13:4887. [PMID: 39201028 PMCID: PMC11355092 DOI: 10.3390/jcm13164887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/11/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Background: The management of patients with aortic valve pathologies can sometimes fall into a "gray zone", where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the "gray zone" of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan-Meier-based meta-analyses to compare the outcomes of SUAVR with the Perceval bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the Perceval bioprosthesis over mid-term and long-term follow-up periods. Methods: The PubMed, PubMed Central, OVID Medline, Cochrane Library, Embase, and Web of Science databases were systematically searched. All study types were included, except study protocols and animal studies, without time restrictions. The final search was carried out in May 2024. Results: No statistically significant differences were observed in permanent pacemaker implantation (PPI) rates between the two groups. SUAVR showed a lower incidence of new-onset myocardial infarction but was associated with higher rates of new-onset atrial fibrillation and major bleeding. TAVI had higher rates of left bundle branch block and major vascular complications. Conclusions: Our findings show that SUAVR has a lower incidence of complications and a favorable mid-term overall survival compared to TAVI. SUAVR has more advantages compared to TAVI and can be considered a valuable and promising option for the "grey zone" of aortic valve pathologies.
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Affiliation(s)
- Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Sho Takemoto
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
| | - Saeed Shafiei
- Department of Cardiac and Thoracic Vascular Surgery, Marburg University Hospital, 35043 Marburg, Germany
| | - Senol Yavuz
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, 16310 Bursa, Turkey
| | | | - Lukman Amanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Bastian Schmack
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Aron-Frederik Popov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield UB9 6JH, UK
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Alexander Weymann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
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Bacco LD, D’Alonzo M, Eusanio MD, Rosati F, Solinas M, Baudo M, Folliguet T, Benussi S, Fischlein T, Muneretto C. Sutureless Aortic Valve Replacement vs. Transcatheter Aortic Valve Implantation in Patients with Small Aortic Annulus: Clinical and Hemodynamic Outcomes from a Multi-Institutional Study. Braz J Cardiovasc Surg 2024; 39:e20230155. [PMID: 39038084 PMCID: PMC11259373 DOI: 10.21470/1678-9741-2023-0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/21/2023] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE This study aimed to compare hemodynamic performances and clinical outcomes of patients with small aortic annulus (SAA) who underwent aortic valve replacement by means of sutureless aortic valve replacement (SUAVR) or transcatheter aortic valve implantation (TAVI). METHODS From 2015 to 2020, 622 consecutive patients with SAA underwent either SUAVR or TAVI. Through a 1:1 propensity score matching analysis, two homogeneous groups of 146 patients were formed. Primary endpoint: all cause-death at 36 months. Secondary endpoints: incidence of moderate to severe patient-prosthesis mismatch (PPM) and incidence of major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS All-cause death at three years was higher in the TAVI group (SUAVR 12.2% vs. TAVI 21.0%, P=0.058). Perioperatively, comparable hemodynamic performances were recorded in terms of indexed effective orifice area (SUAVR 1.12 ± 0.23 cm2/m2 vs. TAVI 1.17 ± 0.28 cm2/m2, P=0.265), mean transvalvular gradients (SUAVR 12.9 ± 5.3 mmHg vs. TAVI 12.2 ± 6.2 mmHg, P=0.332), and moderate-to-severe PPM (SUAVR 4.1% vs. TAVI 8.9%, P=0.096). TAVI group showed a higher cumulative incidence of MACCEs at 36 months (SUAVR 18.1% vs. TAVI 32.6%, P<0.001). Pacemaker implantation (PMI) and perivalvular leak ≥ 2 were significantly higher in TAVI group and identified as independent predictors of mortality (PMI: hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.34-6.94, P=0.008; PPM: HR 2.72, 95% CI 1.25-5.94, P=0.012). CONCLUSION In patients with SAA, SUAVR and TAVI showed comparable hemodynamic performances. Moreover, all-cause death and incidence of MACCEs at follow-up were significantly higher in TAVI group.
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Affiliation(s)
- Lorenzo Di Bacco
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Michele D’Alonzo
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Marco Di Eusanio
- Cardiovascular Surgery Department, Ospedali Riuniti, Ancona, Italy
| | - Fabrizio Rosati
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital,
Massa, Italy
| | - Massimo Baudo
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Thierry Folliguet
- Cardiac surgery, Centre Hospitalier Universitaire Mondor,
Créteil, France
| | - Stefano Benussi
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg,
Germany
| | - Claudio Muneretto
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
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Lamberigts M, Szecel D, Rega F, Verbrugghe P, Dubois C, Meuris B. Sutureless aortic valves in isolated and combined procedures: Thirteen years of experience in 784 patients. J Thorac Cardiovasc Surg 2024; 167:1724-1732.e1. [PMID: 36404146 DOI: 10.1016/j.jtcvs.2022.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcome and experience of the Perceval sutureless valve at our institution (UZ Leuven). METHODS Between 2007 and 2019, 784 patients underwent sutureless aortic valve replacement using the Perceval valve (isolated or combined with other procedures). We performed a retrospective analysis of the postoperative and follow-up data. RESULTS Mean age was 78 years with a median European System for Cardiac Operative Risk Evaluation II score of 4.2% (interquartile range, 2.6%-7.2%). Isolated aortic valve replacement accounted for 45% of cases; 30% of cases were aortic valve replacement in combination with coronary artery bypass grafting and the remaining 25% were other combined procedures. The median crossclamp times were 38 minutes in single aortic valve replacement, 70 minutes in cases with coronary artery bypass grafting, and 89 minutes in multiple valve cases. Device success was 99.1% and in-hospital mortality was 3.3%. Postoperative stroke or transient ischemic attack occurred in 1.9% of patients and 1% of patients had a new need for dialysis after surgery and median survival time was 7.0 years with a cumulative follow-up of 2797.8 patient-years. The 1-, 5-, and 10-year freedom from reintervention were 99%, 97%, and 94%, respectively. CONCLUSIONS These data represent the longest follow-up available, to our knowledge, for the Perceval sutureless valve. We observed favorable early outcomes, and low rates of early mortality, stroke, and other major complications. Valve durability is promising with low rates of valve degeneration and a limited need for reintervention.
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Affiliation(s)
| | | | - Filip Rega
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | | | | | - Bart Meuris
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
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Nakayama T, Nakamura Y, Shikata F, Ushijima M, Yasumoto Y, Yoshiyama D, Kuroda M, Sawa S, Tsuruta R, Furutachi A, Narita T, Ito Y. Thrombocytopenia Following Perceval Sutureless Aortic Valve Replacement in Asian Patients. Circ J 2024; 88:549-558. [PMID: 36709983 DOI: 10.1253/circj.cj-22-0587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study analyzed the safety and performance of the Perceval valve for aortic valve replacement (AVR) in patients at 1 year after undergoing aortic stenosis (AS) treatment, and its effect on significant declines in the platelet count during the immediate postoperative period. METHODS AND RESULTS Data were collected retrospectively for the initial 121 patients (median age 77 years; 47.1% females) who underwent Perceval sutureless AVR between May 2019 and July 2022. Implantation was successful in all (100%), with median cross-clamp and CPB times of 59 and 100 min, respectively. Postoperative thrombocytopenia (platelet count <50×103/μL) was noted in 80 (66.1%) patients. Multivariate analysis showed advanced age (>80 years), preoperative low platelet count (<200×103/μL), and a sternotomy approach as significant risk factors for postoperative thrombocytopenia. One (0.8%) patient died within 30 days after the procedure. The 2-year site-reported event rate was 14% (n=17) for all-cause mortality, 0.8% (n=1) for cardiac mortality, 4.1% (n=5) for stroke, and 1.7% (n=2) for endocarditis and valve-related reoperation; there were no instances of paravalvular leakage or structural valve deterioration. CONCLUSIONS Thrombocytopenia was common after Perceval sutureless AVR, although its impact was not significant. Although Perceval sutureless AVR was found to be a safe and effective option, preoperative assessment of potential bleeding should be performed and the Perceval valve should not be used for patients with a high bleeding risk.
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Affiliation(s)
- Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | | | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Masaki Ushijima
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Shintaro Sawa
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Akira Furutachi
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Takuya Narita
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
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Fialka NM, EL-Andari R, Wang S, Dokollari A, Kent WDT, Fatehi Hassanabad A. The Perceval Sutureless Bioprosthetic Aortic Valve: Evolution of Surgical Valve Technology. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:125-135. [PMID: 38465600 PMCID: PMC11055413 DOI: 10.1177/15569845241231989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The surgical treatment of aortic stenosis continues to evolve, and sutureless aortic valve replacement (SUAVR) is an emerging technology. With the Perceval S (Corcym, London, UK) as the only true sutureless valve on the market, the objective of this review is to analyze the current literature on Perceval S. Focusing on valve design and deployment as well as applications of the technology for challenging pathology, clinical outcomes are assessed, including a comparison with transcatheter AVR (TAVR). METHODS PubMed and MEDLINE were searched by 3 authors for studies analyzing SUAVR from inception to May 19, 2023. RESULTS SUAVR facilitates minimally invasive surgery and offers an alternative strategy for patients with small aortic annuli. It also has a time-saving advantage for patients who require complex operations. SUAVR results in excellent long-term morbidity, mortality, durability, and hemodynamic function. In comparison with conventional surgical AVR (SAVR), SUAVR does have a greater risk of postoperative pacemaker implantation; however, increasing user experience and refinements in implantation technique have contributed to reductions in this outcome. SUAVR results in morbidity and mortality that is similar to rapid-deployment AVR. Midterm outcomes are superior to TAVR; however, further robust investigation into all of these comparisons is ultimately necessary. CONCLUSIONS SUAVR bridges the gap in technology between SAVR and TAVR. The application of this exciting technology will undoubtedly grow in the coming years, during which additional investigation is paramount to optimize preoperative planning, valve deployment, and reintervention strategies.
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Affiliation(s)
- Nicholas M. Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan EL-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shaohua Wang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Aleksander Dokollari
- Section of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
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Yoshida K, Yoshida S, Hori Y, Tsubota H, Mochizuki R, Nagano T, Koyama T. Totally endoscopic concomitant aortic and mitral valve surgery in junctional epidermolysis bullosa: a case report. J Cardiothorac Surg 2024; 19:102. [PMID: 38378631 PMCID: PMC10877881 DOI: 10.1186/s13019-024-02567-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Junctional epidermolysis bullosa is a rare skin and mucosal disorder characterized by blister formation in response to minor trauma and extracutaneous manifestations. There have been no reports of cardiac surgery and prognostication in patients with epidermolysis bullosa due to skin and mucosal fragility. CASE PRESENTATION A 55-year-old man presented with congenital junctional epidermolysis bullosa, hypertension, and vasospastic angina. He complained of dyspnea on exertion, and transthoracic echocardiography revealed severe aortic valve regurgitation, moderate aortic valve stenosis (tricuspid valve), and severe mitral valve regurgitation. Considering that the skin condition in the right chest wall was relatively healthy, the right thoracotomy approach was preferred and totally endoscopic concomitant mitral valve repair and aortic valve replacement were performed using a sutureless bioprosthetic valve (Perceval™ (Corcym, Group, Milan, Italy)). Polyurethane and silicon dressing foams were used to protect the skin at the site of contact with the bag valve mask, arterial pressure catheter, intravenous catheter, and the tracheal intubation tube. Vertical mattress sutures were used for the skin sutures. The postoperative course was uneventful, and the patient was discharged nine days after the operation. There was no indication for reoperation until three years follow-up period. CONCLUSIONS The totally endoscopic concomitant aortic and mitral valve surgery using Perceval™ prosthesis can be performed safely in patients with junctional epidermolysis bullosa by adequate protection of the skin and mucosa.
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Affiliation(s)
- Kazufumi Yoshida
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Soshi Yoshida
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yoshimasa Hori
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Hideki Tsubota
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Ryosuke Mochizuki
- Department of Dermatology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tohru Nagano
- Department of Dermatology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
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Muneretto C, Di Bacco L, Pollari F, Baudo M, Solinas M, D'Alonzo M, Di Eusanio M, Rosati F, Folliguet T, Fischlein T. Sutureless versus transcatheter valves in patients with aortic stenosis at intermediate risk: A multi-institutional European study. Surgery 2023; 174:1153-1160. [PMID: 37714757 DOI: 10.1016/j.surg.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/06/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Recent randomized controlled trials showed comparable short-term outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in intermediate and low-risk patients. However, independent studies comparing transcatheter aortic valve implantation results versus surgical aortic valve replacement at 5 years showed worsening outcomes in patients treated with transcatheter aortic valve implantation. The aim of this study was to analyze mid- to long-term outcomes of patients with isolated aortic stenosis and an intermediate-risk profile who underwent aortic valve replacement using a sutureless valve versus transcatheter aortic valve implantation. METHODS This retrospective multi-institutional European study investigated 2,123 consecutive patients with isolated aortic stenosis at intermediate risk profile treated with sutureless aortic valve replacement (824 patients) or transcatheter aortic valve implantation (1,299 patients) from 2013 to 2020. After 1:1 propensity score matching, 2 balanced groups of 517 patients were obtained. Primary endpoints were as follows: 30 days, late all-cause, and cardiac-related mortality. Secondary endpoints included major adverse cardiocerebrovascular events (all-cause death, stroke/transient ischemic attack, endocarditis, reoperation, permanent pacemaker implantation, and paravalvular leak grade ≥2). RESULTS Median follow-up was 4.3 years (interquartile range 1.1-7.4 years). Primary endpoints were as follows-30-day mortality sutureless aortic valve replacement: 2.13% versus transcatheter aortic valve implantation: 4.64% (P = .026), all-cause mortality sutureless aortic valve replacement: 36.7% ± 7.8% vs transcatheter aortic valve implantation: 41.8% ± 8.2% (P = .023), and cardiac-related mortality sutureless aortic valve replacement: 10.2% ± 2.8% vs transcatheter aortic valve implantation: 19.2% ± 3.5%;(P = .00043) at follow-up. Secondary endpoints were as follows-major adverse cardiocerebrovascular events in the sutureless aortic valve replacement group: 47.2% ± 9.0% versus transcatheter aortic valve implantation: 57.3% ± 7.5% (P < .001). In particular, the incidence of permanent pacemaker implantation (sutureless aortic valve replacement: 6.38% versus transcatheter aortic valve implantation: 11.8% [P = .002]) and paravalvular leak ≥2 (sutureless aortic valve replacement: 0.97% versus transcatheter aortic valve implantation: 4.84% [P = .001]) was significantly higher in transcatheter aortic valve implantation group. At Multivariable Cox regression analysis, paravalvular leak ≥2 (hazard ratio: 1.63%; 95% confidence interval: 1.06-2.53, P = .042) and permanent pacemaker implantation (hazard ratio: 1.49%; 95% confidence interval: 1.02-2.20, P = .039) were identified as predictors of mortality. CONCLUSION Sutureless aortic valve replacement showed a significantly lower incidence of all-cause mortality, cardiac-related death, permanent pacemaker implantation, and paravalvular leak than transcatheter aortic valve implantation. Moreover, permanent pacemaker implantation and paravalvular leak negatively affected survival in patients treated for isolated aortic stenosis.
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Affiliation(s)
- Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, University of Brescia Medical School, Italy
| | - Francesco Pollari
- Universitaets Klinik der Paracelsus Medizinischen Privatuniversitaet, Nuremberg, Germany
| | - Massimo Baudo
- Division of Cardiac Surgery, University of Brescia Medical School, Italy
| | | | - Michele D'Alonzo
- Division of Cardiac Surgery, University of Brescia Medical School, Italy.
| | - Marco Di Eusanio
- Cardiac Surgery, Lancisi Cardiovascular Center, Politechnic University of Marche, Ancona, Italy
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Italy
| | - Thierry Folliguet
- Department of Cardiac Surgery, Henri Mondor Hospital, AP-HP, University Paris Est Créteil, France
| | - Theodor Fischlein
- Universitaets Klinik der Paracelsus Medizinischen Privatuniversitaet, Nuremberg, Germany
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Kaitovic M, Micovic S, Nesic I, Raickovic T, Dotlic J, Stojanovic I, Gazibara T. An Analysis of Early Results after Valve Replacement in Isolated Aortic Valve Stenosis by Using Sutureless vs. Stented Bioprostheses: A Single-Center Middle-Income Country Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1032. [PMID: 37374235 DOI: 10.3390/medicina59061032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: There is a lack of data about the survival of patients after the implantation of sutureless relative to stented bioprostheses in middle-income settings. The objective of this study was to compare the survival of people with isolated severe aortic stenosis after the implantation of sutureless and stented bioprostheses in a tertiary referral center in Serbia. Materials and Methods: This retrospective cohort study included all people treated for isolated severe aortic stenosis with sutureless and stented bioprostheses from 1 January 2018 to 1 July 2021 at the Institute for Cardiovascular Diseases "Dedinje". Demographic, clinical, perioperative and postoperative data were extracted from the medical records. The follow-up lasted for a median of 2 years. Results: The study sample comprised a total of 238 people with a stented (conventional) bioprosthesis and 101 people with a sutureless bioprosthesis (Perceval). Over the follow-up, 13.9% of people who received the conventional and 10.9% of people who received the Perceval valve died (p = 0.400). No difference in the overall survival was observed (p = 0.797). The multivariate Cox proportional hazard model suggested that being older, having a higher preoperative EuroScore II, having a stroke over the follow-up period and having valve-related complications were independently associated with all-cause mortality over a median of 2 years after the bioprosthesis implantation. Conclusions: This research conducted in a middle-income country supports previous findings in high-income countries regarding the survival of people with sutureless and stented valves. Survival after bioprosthesis implantation should be monitored long-term to ensure optimum postoperative outcomes.
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Affiliation(s)
- Marko Kaitovic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Slobodan Micovic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Nesic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tatjana Raickovic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
| | - Jelena Dotlic
- Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, 11000 Belgrade, Serbia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Stojanovic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Dokollari A, Torregrossa G, Bisleri G, Hassanabad AF, Sa MP, Sicouri S, Veshti A, Prifti E, Bacchi B, Cabrucci F, Ramlawi B, Bonacchi M. Early and Long-Term Clinical and Echocardiographic Outcomes of Sutureless vs. Sutured Bioprosthesis for Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:jcdd10050224. [PMID: 37233191 DOI: 10.3390/jcdd10050224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
Objective: The goal of this manuscript is to compare clinical and echocardiographic outcomes of patients undergoing aortic valve replacement (AVR) with Perceval sutureless bioprosthesis (SU-AVR) and sutured bioprosthesis (SB). Methods: Following the PRISMA statement, data were extracted from studies published after August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post-procedural permanent pacemaker implantation, and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop-out), need for a second transcatheter heart valve, 30-day mortality, stroke, and echocardiographic outcomes. Results: Twenty-one studies were included in the analysis. When SU-AVR was compared to other SB, mortality ranged from 0 to 6.4% for Perceval and 0 to 5.9% for SB. Incidence of PVL (Perceval 1-19.4% vs. SB 0-1%), PPI (Perceval 2-10.7% vs. SB 1.8-8.5%), and MI (Perceval 0-7.8% vs. SB 0-4.3%) were comparable. In addition, the stroke rate was lower in the SU-AVR group when compared to SB (Perceval 0-3.7% vs. SB 1.8-7.3%). In patients with a bicuspid aortic valve, the mortality rate was 0-4% and PVL incidence was 0-2.3%. Long-term survival ranged between 96.7 and 98.6%. Valve cost analysis was lower for the Perceval valve and higher for sutured bioprosthesis. Conclusions: Compared to SB valves, Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its non-inferior hemodynamics, implantation speed, reduced cardiopulmonary bypass time, reduced aortic cross-clamp time, and shorter length of stay.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | | | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| | - Michel Pompeu Sa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Altin Veshti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Edvin Prifti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Beatrice Bacchi
- St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Francesco Cabrucci
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Massimo Bonacchi
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
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10
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Jolliffe J, Moten S, Tripathy A, Skillington P, Tatoulis J, Muneretto C, Di Bacco L, Galvao HBF, Goldblatt J. Perceval valve intermediate outcomes: a systematic review and meta-analysis at 5-year follow-up. J Cardiothorac Surg 2023; 18:129. [PMID: 37041628 PMCID: PMC10091543 DOI: 10.1186/s13019-023-02273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES New technologies for the treatment of Aortic Stenosis are evolving to minimize risk and treat an increasingly comorbid population. The Sutureless Perceval Valve is one such alternative. Whilst short-term data is promising, limited mid-term outcomes exist, until now. This is the first systematic review and meta-analysis to evaluate mid-term outcomes in the Perceval Valve in isolation. METHODS A systematic literature review of 5 databases was performed. Articles included evaluated echocardiographic and mortality outcomes beyond 5 years in patients who had undergone Perceval Valve AVR. Two reviewers extracted and reviewed the articles. Weighted estimates were performed for all post-operative and mid-term data. Aggregated Kaplan Meier curves were reconstructed from digitised images to evaluate long-term survival. RESULTS Seven observational studies were identified, with a total number of 3196 patients analysed. 30-day mortality was 2.5%. Aggregated survival at 1, 2, 3, 4 and 5 years was 93.4%, 89.4%, 84.9%, 82% and 79.5% respectively. Permanent pacemaker implantation (7.9%), severe paravalvular leak (1.6%), structural valve deterioration (1.5%), stroke (4.4%), endocarditis (1.6%) and valve explant (2.3%) were acceptable at up to mid-term follow up. Haemodynamics were also acceptable at up mid-term with mean-valve gradient (range 9-13.6 mmHg), peak-valve gradient (17.8-22.3 mmHg) and effective orifice area (1.5-1.8 cm2) across all valve sizes. Cardiopulmonary bypass (78 min) and Aortic cross clamp times (52 min) were also favourable. CONCLUSION To our knowledge, this represents the first meta-analysis to date evaluating mid-term outcomes in the Perceval Valve in isolation and demonstrates good 5-year mortality, haemodynamic and morbidity outcomes. KEY QUESTION What are the mid-term outcomes at up to 5 years follow up in Perceval Valve Aortic Valve Replacement? KEY FINDINGS Perceval Valve AVR achieves 80% freedom from mortality at 5 years with low valve gradients and minimal morbidity. KEY OUTCOMES Perceval Valve Aortic Valve Replacement has acceptable mid-term mortality, durability and haemodynamic outcomes.
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Affiliation(s)
- Jarrod Jolliffe
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia.
| | - Simon Moten
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Amit Tripathy
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Peter Skillington
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - James Tatoulis
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | | | - Lorenzo Di Bacco
- School of Cardiac Surgery, University of Brescia, Brescia, Italy
| | | | - John Goldblatt
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
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11
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Sakata T, De La Pena C, Ohira S. Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations. Vasc Health Risk Manag 2023; 19:169-180. [PMID: 37016696 PMCID: PMC10066891 DOI: 10.2147/vhrm.s374410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Sutureless or rapid deployment valves in the setting of aortic valve replacement (AVR) is an emerging surgical technique using the transcatheter valve technology, which may lead to reduction in cross-clamp time and potentially better hemodynamics compared to a stented bioprosthetic valve. The absence of subannular pledgets results to excellent hemodynamic performance with reduced turbulent flow and larger effective orifice area. However, complications from both surgical and transcatheter AVR may still occur and impact survival. The incidence of paravalvular leakage and permanent pacemaker implantation are not low. Although technical modifications can improve these outcomes, there is a learning curve effect. Therefore, technical and anatomical considerations as well as better patient selection are paramount for better outcomes. In this review, we discuss the use of sutureless or rapid deployment valves in setting of (1) complex procedures, (2) minimally invasive AVR, and (3) small aortic annulus. The advantage of sutureless or rapid deployment valves in terms of mortality remains to be clarified; therefore, it is necessary to accumulate long-term outcomes in an appropriate patient cohort.
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Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corazon De La Pena
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Correspondence: Suguru Ohira, Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Macy Pavilion, Valhalla, NY, 10595, USA, Tel +1 404 234 5433, Email
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12
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Pollari F, Mamdooh H, Hitzl W, Grossmann I, Vogt F, Fischlein T. Ten years' experience with the sutureless aortic valve replacement: incidence and predictors for survival and valve durability at follow-up. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2023; 63:6935788. [PMID: 36534823 DOI: 10.1093/ejcts/ezac572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Aortic valve replacement with a sutureless prosthesis [sutureless aortic valve replacement (Su-AVR)] is an option for patients with severe aortic valve stenosis. However, data regarding long-term outcomes and prosthesis durability are still lacking. METHODS All consecutive patients who successfully underwent Su-AVR with the Perceval valve in our centre between 2010 and 2020 were included in the analysis and followed prospectively with echocardiography. Risk factor analysis was performed to assess variables associated with worse survival and bioprosthetic valve failure. RESULTS Study population consisted of 547 patients: the mean age was 76.4 (5.2) years, 51% were female and the mean logistic EuroSCORE was 13% (11). The median survival was 7.76 years [95% confidence interval (CI) = 6.9-8.6]. Risk factor analysis identified age [hazard ratio (HR) 1.06, 95% CI 1.03-1.11; P < 0.001), EuroSCORE II (HR 1.08, 1.02-1.13; P < 0.001), baseline dialysis (HR 2.14, 95% CI 1.4-4.4; P = 0.038) and postoperative acute kidney injury ≥2 (HR 8.97, 95% CI 4.58-17.6; P < 0.001) as factors significantly correlated with worse survival. The reported HRs for age are per 1 year and for EuroSCORE II is 1 percentage point. Structural valve deterioration (SVD) was observed in 23 patients, of whom 19 underwent reintervention (median freedom from SVD 10.3 years). In multivariable Cox analysis, age (HR 0.89, 95% CI 0.82-0.95; P < 0.001) was found to be a significant predictor of SVD. Overall, 1.8% was referred for prosthetic valve endocarditis (confirmed or suspected) during follow-up. One patient showed moderate non-SVD and none developed prosthetic valve thrombosis. CONCLUSIONS The sutureless valve represents a reliable bioprosthesis for aortic valve replacement in patients with a 10-year life expectancy. Younger age at the time of implant is the only factor associated with the risk of long-term SVD.
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Affiliation(s)
- Francesco Pollari
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Hazem Mamdooh
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Hitzl
- Research and Innovation Management (RIM) Department, Biostatistics and Publication of Clinical Trials, Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Irena Grossmann
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
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13
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Safety and Efficacy of the Transaxillary Access for Minimally Invasive Aortic Valve Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010160. [PMID: 36676784 PMCID: PMC9860976 DOI: 10.3390/medicina59010160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023]
Abstract
Background and Objectives: Transaxillary access is one of the latest innovations for minimally invasive aortic valve replacement (MICS-AVR). This study compares clinical performance in a large transaxillary MICS-AVR group to a propensity-matched sternotomy control group. Materials and Methods: This study enrolled 908 patients undergoing isolated AVR with a mean age of 69.4 ± 18.0 years, logistic EuroSCORE of 4.0 ± 3.9%, and body mass index (BMI) of 27.3 ± 6.1 kg/m2. The treatment group comprised 454 consecutive transaxillary MICS-AVR patients. The control group was 1:1 propensity-matched out of 3115 consecutive sternotomy aortic valve surgeries. Endocarditis, redo, and combined procedures were excluded. The multivariate matching model included age, left ventricular ejection fraction, logistic EuroSCORE, pulmonary hypertension, coronary artery disease, chronic lung disease, and BMI. Results: Propensity-matching was successful with subsequent comparable clinical baselines in both groups. MICS-AVR had longer skin-to-skin time (120.0 ± 31.5 min vs. 114.2 ± 28.7 min; p < 0.001) and more frequent bleeding requiring chest reopening (5.0% vs. 2.4%; p < 0.010), but significantly less packed red blood cell transfusions (0.57 ± 1.6 vs. 0.82 ± 1.6; p = 0.040). In addition, MICS-AVR patients had fewer access site wound abnormalities (1.5% vs. 3.7%; p = 0.038), shorter intensive care unit stays (p < 0.001), shorter ventilation times (p < 0.001), and shorter hospital stays (7.0 ± 5.1 days vs. 11.1 ± 6.5; p < 0.001). No significant differences were observed in stroke > Rankin 2 (0.9% vs. 1.1%; p = 0.791), renal replacement therapy (1.5% vs. 2.4%; p = 0.4762), and hospital mortality (0.9% vs. 1.5%; p = 0.546). Conclusions: Transaxillary MICS-AVR is at least as safe as AVR by sternotomy and can be performed in the same time frame. Its advantages are fewer transfusions and quicker postoperative recovery with a significantly shorter hospital stay. The cosmetic result and unrestricted physical abilities due to the untouched sternum and ribs are unique advantages of transaxillary access.
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14
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Sá MP, Van den Eynde J, Erten O, Sicouri S, Ramlawi B. Sternal-sparing aortic valve replacement with sutureless valve in bicuspid valve. J Card Surg 2022; 37:5653-5662. [PMID: 36378946 DOI: 10.1111/jocs.17185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
Over the last decade, sutureless valves (Perceval, LivaNova PLC) were brought to the market as an alternative to stented valves for patients requiring surgical aortic valve replacement (SAVR). However, Perceval demands special steps for implantation, among which we can mention specific training for the surgical team members. Sternal-sparing cardiac procedures are conceived to limit surgical trauma, but the technical requirements and preoperative planning are more challenging than those for conventional sternotomy. SAVR is frequently carried out through an upper hemisternotomy, but the right anterior thoracotomy (RAT) represents an even less traumatic, technical advancement. In the context of SAVR with RAT, Perceval has been considered the "perfect marriage." In patients with bicuspid aortic valve (BAV), some surgeons initially avoided the Perceval valve but, with growing experience, the prosthesis has been used for a wide variety of indications. According to an international consensus statement recently published, there are 3 BAV types: the fused BAV, the 2-sinus BAV and the partial-fusion BAV, each with specific phenotypes. The 2-sinus BAV has 2 cusps, roughly equal in size and shape, each cusp occupying 180° of the annular circumference, with only 2 aortic sinuses, resulting in a 2-sinus/2-cusp valve without raphe and with 180° commissural angles. Since the elliptic aortic annulus in BAV patients poses a challenge for sutureless valves and the RAT approach has been increasingly adopted for minimally invasive SAVR, our description of the surgical technique focuses on the specific procedural details in the scenario of 2-sinus BAV laterolateral phenotype.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
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15
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Giraldo-Molano MA, Pérez-Camargo D, Carnero-Alcázar M, Montero-Cruces L, Campelos-Fernández P, Reguillo-Lacruz F, Cobiella-Carnicer J, Maroto Castellanos LC. Sustitución valvular aórtica con bioprótesis convencionales o sin sutura: resultados clínicos y comportamiento hemodinámico a 3 años. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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16
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King M, Stambulic T, Payne D, Fernandez AL, El-Diasty M. The use of sutureless and rapid-deployment aortic valve prosthesis in patients with bicuspid aortic valve: A focused review. J Card Surg 2022; 37:3355-3362. [PMID: 35904115 DOI: 10.1111/jocs.16795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/01/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this scoping review is to describe the postoperative outcomes and complications of patients with bicuspid aortic valve (BAV) treated with sutureless or rapid-deployment prosthesis. BACKGROUND 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 into patients with BAV with varying degrees of success. The focus of this review is to consolidate the current available evidence on this topic. METHODS A scoping review was conducted using a comprehensive search strategy in multiple databases (Medline, Embase, 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. Thirteen articles, including case reports and case series were ultimately included for analysis. RESULTS 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 15 mmHg in all studies with mean postoperative aortic valvular areas all greater than 1.3 cm.2 There were 186 total complications for an overall complication 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). CONCLUSIONS The use of sutureless and rapid deployment prostheses in patients with BAV showed comparable intraoperative and implantation success rates to patients without BAV. Postoperative complications from using these prostheses in patients with BAV included new onset atrial fibrillation, intraprosthetic aortic regurgitation, new onset atrioventricular block, and required pacemaker insertion. Various techniques have been described to minimize these complications in patients with BAV receiving sutureless or rapid deployment prostheses.
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Affiliation(s)
- Morgan King
- Queen's School of Medicine, Kingston, Ontario, Canada
| | | | - Darrin Payne
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Angel Luis Fernandez
- Cardiac Surgery Department, University of Santiago de Compostela, Santiago, Spain
| | - Mohammad El-Diasty
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
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17
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Nakamura Y, Narita T, Kuroda M, Nakayama T, Tsuruta R, Yoshiyama D, Yasumoto Y, Sawa S, Furutachi A, Ito Y. Sutureless Aortic Valve Replacement Through Lateral Mini-Thoracotomy - Feasibility and Effectiveness. Circ J 2022; 86:1733-1739. [PMID: 35896351 DOI: 10.1253/circj.cj-22-0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Minimally invasive sutureless aortic valve replacement with the Perceval bioprosthetic heart valve (MISUAVR) is commonly performed through a right anterior thoracotomy (AT). However, a lateral thoracotomy (LT) may be superior as it does not require rib and right internal thoracic artery (RITA) cutting.Methods and Results: In total, 38 MISUAVRs performed from May 2019 to approximately August 2021 were retrospectively reviewed; 21 through LT (Group L), and 17 through AT (Group A). In Group L, the skin incision was made on the right anterior axillary line and third intercostal space, and in group A, on the right anterior chest and second or third intercostal space. All other surgical techniques were the same. Age, body surface area, EuroSCORE II, and ejection fraction were similar between the patients. Cardiopulmonary bypass (L: 82±19 vs. A: 93±28 min, P=0.19) and cross-clamp times (L: 57±13, vs. A: 64±23 min, P=0.19) were similar. Rib and/or RITA cutting were required in 94.6% of patients in group A and in none of group L (P<0.001). Surgical visualization score was better in group L (L: 1.19±0.40 vs. A: 1.94±0.69, P<0.01). Total amount of intraoperative bleeding was lower in group L (L: 623±141 vs. A: 838±316 mL, P<0.01). Duration of hospital stay was similar (P=0.30). CONCLUSIONS MISUAVR through LT has multiple advantages over AT.
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Affiliation(s)
| | - Takuya Narita
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Shintaro Sawa
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Akira Furutachi
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chibanishi General Hospital
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18
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Fischlein T, Caporali E, Asch FM, Vogt F, Pollari F, Folliguet T, Kappert U, Meuris B, Shrestha ML, Roselli EE, Bonaros N, Fabre O, Corbi P, Troise G, Andreas M, Pinaud F, Pfeiffer S, Kueri S, Tan E, Voisine P, Girdauskas E, Rega F, García-Puente J, De Kerchove L, Lorusso R. Hemodynamic Performance of Sutureless vs. Conventional Bioprostheses for Aortic Valve Replacement: The 1-Year Core-Lab Results of the Randomized PERSIST-AVR Trial. Front Cardiovasc Med 2022; 9:844876. [PMID: 35252408 PMCID: PMC8894864 DOI: 10.3389/fcvm.2022.844876] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveSutureless aortic valves are an effective option for aortic valve replacement (AVR) showing non-inferiority to standard stented aortic valves for major cardiovascular and cerebral events at 1-year. We report the 1-year hemodynamic performance of the sutureless prostheses compared with standard aortic valves, assessed by a dedicated echocardiographic core lab.MethodsPerceval Sutureless Implant vs. Standard Aortic Valve Replacement (PERSIST-AVR) is a prospective, randomized, adaptive, open-label trial. Patients undergoing AVR, as an isolated or combined procedure, were randomized to receive a sutureless [sutureless aortic valve replacement (Su-AVR)] (n = 407) or a stented sutured [surgical AVR (SAVR)] (n = 412) bioprostheses. Site-reported echocardiographic examinations were collected at 1 year. In addition, a subgroup of the trial population (Su-AVR n = 71, SAVR = 82) had a complete echocardiographic examination independently assessed by a Core Lab (MedStar Health Research Institute, Washington D.C., USA) for the evaluation of the hemodynamic performance.ResultsThe site-reported hemodynamic data of stented valves and sutureless valves are stable and comparable during follow-up, showing stable reduction of mean and peak pressure gradients through one-year follow-up (mean: 12.1 ± 6.2 vs. 11.5 ± 4.6 mmHg; peak: 21.3 ± 11.4 vs. 22.0 ± 8.9 mmHg). These results at 1-year are confirmed in the subgroup by the core-lab assessed echocardiogram with an average mean and peak gradient of 12.8 ± 5.7 and 21.5 ± 9.1 mmHg for Su-AVR, and 13.4 ± 7.7 and 23.0 ± 13.0 mmHg for SAVR. The valve effective orifice area was 1.3 ± 0.4 and 1.4 ± 0.4 cm2 at 1-year for Su-AVR and SAVR. These improvements are observed across all valve sizes. At 1-year evaluation, 91.3% (n = 42) of patients in Su-AVR and 82.3% in SAVR (n = 51) groups were free from paravalvular leak (PVL). The rate of mild PVL was 4.3% (n = 2) in Su-AVR and 12.9% (n = 8) in the SAVR group. A similar trend is observed for central leak occurrence in both core-lab assessed echo groups.ConclusionAt 1-year of follow-up of a PERSIST-AVR patient sub-group, the study showed comparable hemodynamic performance in the sutureless and the stented-valve groups, confirmed by independent echo core lab. Perceval sutureless prosthesis provides optimal sealing at the annulus with equivalent PVL and central regurgitation extent rates compared to sutured valves. Sutureless valves are therefore a reliable and essential technology within the modern therapeutic possibilities to treat aortic valve disease.
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Affiliation(s)
- Theodor Fischlein
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
- *Correspondence: Theodor Fischlein
| | - Elena Caporali
- Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Department of Cardiac Surgery, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
- Elena Caporali
| | - Federico M. Asch
- MedStar Health Research Institute, Washington Hospital Center, Washington D.C., DC, United States
| | - Ferdinand Vogt
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Thierry Folliguet
- Cardiac Surgery Unit, Hôpital Henri Mondor, Université Paris 12, Créteil, France
| | - Utz Kappert
- Herzzentrum Dresden GmbH Universitätsklinik, Dresden, Germany
| | - Bart Meuris
- Cardiac Surgery Unit, UZ Gasthuisberg Leuven, Leuven, Belgium
| | - Malakh L. Shrestha
- Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Eric E. Roselli
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Olivier Fabre
- Lens Hospital and Bois Bernard Private Hospital, Lens, France
| | | | - Giovanni Troise
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Frederic Pinaud
- Department of Cardiac Surgery, University Hospital Angers, Angers, France
| | - Steffen Pfeiffer
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Sami Kueri
- University Heart Center Freiburg, Bad Krozingen, Germany
| | - Erwin Tan
- Catharina Ziekenhuis, Eindhoven, Netherlands
| | - Pierre Voisine
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, QC, Canada
| | - Evaldas Girdauskas
- University Heart Center Hamburg, Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg, Germany
| | - Filip Rega
- Cardiac Surgery Unit, UZ Gasthuisberg Leuven, Leuven, Belgium
| | | | | | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
- Cardiac Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
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19
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Dhanekula AS, Nishath T, Aldea GS, Burke CR. Use of the Perceval Sutureless Aortic Valve in Re-Operative Aortic Valve Replacement. JTCVS Tech 2022; 13:31-39. [PMID: 35711205 PMCID: PMC9196321 DOI: 10.1016/j.xjtc.2022.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/17/2022] [Indexed: 10/25/2022] Open
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20
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Dokollari A, Ramlawi B, Torregrossa G, Sá MP, Sicouri S, Prifti E, Gelsomino S, Bonacchi M. Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis. Front Cardiovasc Med 2022; 8:789392. [PMID: 35071358 PMCID: PMC8766961 DOI: 10.3389/fcvm.2021.789392] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/29/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: To highlight the main target points covered by clinical studies on the Perceval sutureless valve for surgical aortic valve replacement (SAVR) and raise a point of discussion for further expansion of its use when compared with stented bioprostheses (SB) and transcatheter aortic valve replacement (TAVR). Methods: We reviewed clinical trials and retrospective studies published up to date and compared the outcomes in terms of mortality, myocardial infarction (MI) stroke, paravalvular leak (PVL), permanent pacemaker implantation (PPI), bleeding and long-term outcomes. Results: Clinical studies showed that 30-day mortality ranged from 0–4% for Perceval and 2.9–7% for TAVR. The incidence of PVL (Perceval 1.9–19.4 vs. TAVR 9–53.5%), PPI (Perceval 2–11.2 vs. TAVR 4.9–25.5%), stroke (Perceval 0 vs. TAVR 0–2.8%), MI (Perceval 0 vs. TAVR 0–3.5%), were all higher in the TAVR group. Compared to other SB, mortality ranged from 0–6.4% for Perceval and 0–5.9% for SB. The incidence of PVR (Perceval 1–19.4 vs. SB 0–1%), PPI (Perceval 2–10.7 vs. SB 1.8–8.5%), stroke (Perceval 0–3.7 vs. SB 1.8–7.3%) and MI (Perceval 0–7.8 vs. SB 0–4.3%) were comparable among the groups. In patients with a bicuspid aortic valve, mortality rate was (0–4%) and PVL incidence was (0–2.3%). However, there was a high incidence of PPI (0–20%), and stroke (0–8%). Long-term survival ranged between 96.7–98.6%. Conclusions: The Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its implantation speed, the reduced cardiopulmonary bypass time, the reduced aortic cross-clamp time and the shorter intensive care unit and hospital length of stay.
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Affiliation(s)
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Edvin Prifti
- Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Sandro Gelsomino
- Department of Cardiac Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, Netherlands
| | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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21
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6548864. [DOI: 10.1093/ejcts/ezac164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
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22
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Woo HS, Hwang HY, Kim HJ, Kim JB, Lee S, Lim C, Chang BC, Lee NR, Suh Y, Choi JW. Changes in the Prosthesis Types Used for Aortic Valve Replacement after the Introduction of Sutureless and Rapid Deployment Valves in Korea: A Nationwide Population-Based Cohort Study. J Chest Surg 2021; 54:369-376. [PMID: 34493693 PMCID: PMC8548199 DOI: 10.5090/jcs.21.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/26/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Sutureless and rapid deployment valves for aortic valve replacement (AVR) were introduced in Korea in December 2016. This study evaluated changing trends in the prosthetic valves used for AVR in Korea after the introduction of sutureless and rapid deployment valves. Methods From December 2016 to December 2018, 4,899 patients underwent AVR in Korea. After applying the exclusion criteria, 4,872 patients were analyzed to determine changes in the type of prosthetic valve used for AVR. The study period was divided into 5 groups corresponding to 5-month intervals. Results The total number of AVR cases was 194.88±28.78 per month during the study period. Mechanical valves were used in approximately 27% to 33% of cases, and the proportion of mechanical valve use showed a tendency to decrease, with marginal significance overall (p=0.078) and significant decreases in patients less than 60 years of age and in men (p=0.013 and p=0.023, respectively). The use of sutureless valves increased from 13.4% to 25.8% of cases (p<0.001), especially in elderly patients (>70 years) and those requiring concomitant surgery. In a comparison between sutureless and rapid deployment valves, the use of Perceval S valves (a type of sutureless valve), gradually increased (p<0.001). Conclusion After the introduction of sutureless and rapid deployment valves in Korea, the rate of use of these new valves remarkably increased, especially in elderly patients and those requiring concomitant surgery. Further studies should investigate the clinical outcomes of these new prostheses.
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Affiliation(s)
- Hyeok Sang Woo
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Seoul, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung-Cheul Chang
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Youshin Suh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
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23
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Berretta P, Meuris B, Kappert U, Andreas M, Fiore A, Solinas M, Misfeld M, Carrel TP, Villa E, Savini C, Santarpino G, Teoh K, Albertini A, Fischlein T, Martinelli G, Mignosa C, Glauber M, Shrestha M, Laufer G, Phan K, Yan T, Di Eusanio M. Sutureless versus rapid deployment aortic valve replacement: results from a multicentric registry. Ann Thorac Surg 2021; 114:758-765. [PMID: 34563505 DOI: 10.1016/j.athoracsur.2021.08.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND To compare clinical and hemodynamic in-hospital outcomes of patients undergoing sutureless versus rapid deployment aortic valve replacement (SURD-AVR) in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS We examined 4695 patients who underwent isolated or combined SURD-AVR. The "sutureless" Perceval valve was used in 3133 patients and the "rapid deployment" Intuity in 1562. Potential confounding factors were addressed by the use of propensity score matching. After matching, 2 well-balanced cohorts of 823 pairs (isolated SURD-AVR) and 467 pairs (combined SURD-AVR) were created. RESULTS Patients who received Perceval and Intuity valves showed similar in-hospital mortality and rate of major postoperative complications. Perceval was associated shorter cross clamp and cardiopulmonary bypass time. In the isolated SURD-AVR group, patients receiving Perceval were more likely to undergo anterior right thoracotomy incision. Postoperative transvalvular gradients were significantly lower for the Intuity valve compared to those of the Perceval valve, either in isolated and combined SURD-AVR. The Intuity valve was associated with a lower rate of postoperative mild aortic regurgitation. CONCLUSIONS Our results confirm the safety and efficacy of SURD-AVR regardless of the valve type. The Perceval valve was associated with reduced operative times and increased anterior right thoracotomy incision. The Intuity valve showed superior hemodynamic outcomes and a lower incidence of postoperative mild aortic regurgitation.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Antonio Fiore
- Henri Mondor Hospital, University of Paris, Paris, France
| | | | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy
| | - Giuseppe Santarpino
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Italy; Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy; Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Kevin Teoh
- Southlake Regional Health Centre, Ontario, Canada
| | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital GVM care & research, Cotignola, Italy
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | | | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | - Mattia Glauber
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | | | - Ghunter Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Tristan Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia; The Collaborative Research (CORE) Group
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy; The Collaborative Research (CORE) Group
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24
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Verlinden J, Bové T, de Kerchove L, Baert J, Radermecker M, Durieux R, Gutermann H, Van Kerrebroeck C, Szecel D, Meuris B. Early conduction disorders after aortic valve replacement with the sutureless Perceval prosthesis. Ann Thorac Surg 2021; 113:1911-1917. [PMID: 34536377 DOI: 10.1016/j.athoracsur.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND To determine the incidence of postoperative conduction disorders and need for pacemaker implantation after aortic valve replacement(AVR) with the Perceval prosthesis. METHODS From January 2007 to December 2017, 908 patients underwent AVR with Perceval S in 5 participating centers. Study endpoints focused on electrocardiographic changes after AVR and the incidence of new pacemaker(PM) implantation in 801 patients after exclusion of patients with previous PM(n=48) or patients undergoing tricuspid(n=28) and/or AF ablation(n=31) surgery. Logistic regression analysis was performed to determine risk factors for PM need. RESULTS Mean age was 79.7±5.2 years, 476(59.4%) were females. Median logistic Euroscore II was 4.1%(IQR 2.6-6.0). Isolated AVR was performed in 441(55.1%) patients. Associated procedures were CABG(n=309, 38.6%) and mitral valve surgery(n=51, 6.4%). Overall 30d-mortality was 3.9%, and 2.8% for isolated AVR. Electrocardiographic changes included a significant increase of LBBB (7.4 to 23.7%, p<0.001) and development of complete AV block, requiring PM implantation in 9.5%. Multivariable analysis revealed independent of a learning period(OR 1.91, 95%CI 1.16-3.13, p=0.011), pre-existing RBBB(OR 2.77, 95%CI 1.40-5.48, p=0.003), intra-operative prosthesis repositioning(OR 6.70, 95%CI 1.89-24.40, p=0.003) and size XL(OR 6.81, 95%CI 1.55-29.96, p=0.011) as significant predictors of PM implantation. CONCLUSIONS In a challenging elderly population, use of the Perceval S for AVR provides low operative mortality, but at the risk of an increased PM implantation rate. Besides to pre-existing right-bundle branch block, the significant effect of size XL, an increased valve size/BSA ratio and need for intra-operative repositioning on PM rate are underscoring the reappraisal of the annular sizing policy.
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Affiliation(s)
| | | | | | - Jerome Baert
- University Hospital UCL St Luc-Brussels, Brussels, Belgium
| | | | | | | | | | | | - Bart Meuris
- University Hospital KUL Leuven, Leuven, Belgium
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25
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Santarpino G, Lorusso R, Moscarelli M, Mikus E, Wisniewski K, Dell'Aquila AM, Margari V, Carrozzo A, Barbato L, Fiorani V, Lamarra M, Fattouch K, Squeri A, Giannini F, Marchese A, Farahani K, Gregorini R, Comoglio C, Martinelli L, Calvi S, Avolio M, Paparella D, Albertini A, Speziale G. Sutureless versus transcatheter aortic valve replacement: A multicenter analysis of "real-world" data. J Cardiol 2021; 79:121-126. [PMID: 34518075 DOI: 10.1016/j.jjcc.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent data suggested that transcatheter aortic valve replacement (TAVR) may be indicated also for low-risk patients. However, robust evidence is still lacking, particularly regarding valve performance at follow-up that confers a limitation to its use in young patients. Moreover, a literature gap exists in terms of 'real-world' data analysis. The aim of this study is to compare the cost-effectiveness of sutureless aortic valve replacement (SuAVR) versus transfemoral TAVR. METHODS Prospectively collected data were retrieved from a centralized database of nine cardiac surgery centers between 2010 and 2018. Follow-up was completed in June 2019. A propensity score matching (PSM) analysis was performed. RESULTS Patients in the TAVR group (n=1002) were older and with more comorbidities than SuAVR patients (n=443). The PSM analysis generated 172 pairs. No differences were recorded between groups in 30-day mortality [SuAVR vs TAVR: n=7 (4%) vs n=5 (2.9%); p=0.7] and need for pacemaker implant [n=10 (5.8%) vs n=20 (11.6%); p=0.1], but costs were lower in the SuAVR group (20486.6±4188€ vs 24181.5±3632€; p<0.01). Mean follow-up was 1304±660 days. SuAVR patients had a significantly higher probability of survival than TAVR patients (no. of fatal events: 22 vs 74; p<0.014). Median follow-up was 2231 days and 2394 days in the SuAVR and TAVR group, respectively. CONCLUSION The treatment of aortic valve stenosis with surgical sutureless or transcatheter prostheses is safe and effective. By comparing the two approaches, patients who can undergo surgery after heart team evaluation show longer lasting results and a more favorable cost ratio.
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Affiliation(s)
- Giuseppe Santarpino
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy; Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany; Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University "Magna Graecia", Catanzaro (CZ), Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Hospital, Maastricht, the Netherlands
| | - Marco Moscarelli
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy
| | - Elisa Mikus
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola (RA), Italy
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany.
| | | | - Vito Margari
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy
| | - Alessandro Carrozzo
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo (GE), Italy
| | - Luciano Barbato
- Maria Pia Hospital, Department of Cardiac Surgery, GVM Care & Research, Turin, Italy
| | - Vinicio Fiorani
- Salus Hospital, Department of Cardiac Surgery, GVM Care & Research, Reggio Emilia, Italy
| | - Mauro Lamarra
- Villa Torri, Department of Cardiac Surgery, GVM Care & Research, Bologna, Italy
| | - Khalil Fattouch
- Maria Eleonora Hospital, Department of Cardiac Surgery, GVM Care & Research, Palermo, Italy
| | - Angelo Squeri
- Maria Cecilia Hospital, Department of Cardiology, GVM Care & Research, Cotignola (RA), Italy
| | - Francesco Giannini
- Maria Cecilia Hospital, Department of Cardiology, GVM Care & Research, Cotignola (RA), Italy
| | - Alfredo Marchese
- Santa Maria Hospital, Department of Cardiology, GVM Care & Research, Bari, Italy
| | - Kia Farahani
- Città di Lecce Hospital, Department of Cardiology, GVM Care & Research, Lecce, Italy
| | - Renato Gregorini
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy
| | - Chiara Comoglio
- Maria Pia Hospital, Department of Cardiac Surgery, GVM Care & Research, Turin, Italy
| | - Luigi Martinelli
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo (GE), Italy
| | - Simone Calvi
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola (RA), Italy
| | - Maria Avolio
- Clinical Data Management, GVM Care & Research, Rome, Italy
| | - Domenico Paparella
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy; Department of Emergency and Organ Transplant, Aldo Moro University of Bari, Bari, Italy
| | - Alberto Albertini
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola (RA), Italy
| | - Giuseppe Speziale
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy
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26
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Balmforth D, Dimagli A, Benedetto U, Uppal R. Fifty years of the pericardial valve: Long-term results in the aortic position. J Card Surg 2021; 36:2865-2875. [PMID: 33982282 DOI: 10.1111/jocs.15604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
It is now 50 years since the development of the first pericardial valve in 1971. In this time significant progress has been made in refining valve design aimed at improving the longevity of the prostheses. This article reviews the current literature regarding the longevity of pericardial heart valves in the aortic position. Side by side comparisons of freedom from structural valve degeneration are made for the valves most commonly used in clinical practice today, including stented, stentless, and sutureless valves. Strategies to reduce structural valve degeneration are also discussed including methods of tissue fixation and anti-calcification, ways to minimise mechanical stress on the valve, and the role of patient prosthesis mismatch.
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Affiliation(s)
| | | | | | - Rakesh Uppal
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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27
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MID-TERM OUTCOME OF PERCEVAL SUTURELESS PROSTHESIS: DIFFERENT DEFINITIONS, SAME GOOD RESULTS. Ann Thorac Surg 2021; 112:2115. [PMID: 33621554 DOI: 10.1016/j.athoracsur.2020.12.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
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28
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Meuris B, Rega F, Verbrugghe P. Perceval: the bottom line. Ann Thorac Surg 2021; 112:1382. [PMID: 33571496 DOI: 10.1016/j.athoracsur.2020.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Bart Meuris
- University Hospitals Leuven, Cardiac Surgery, Herestraat 49 3000, Leuven, Belgium.
| | - Filip Rega
- University Hospitals Leuven, Cardiac Surgery, Herestraat 49 3000, Leuven, Belgium
| | - Peter Verbrugghe
- University Hospitals Leuven, Cardiac Surgery, Herestraat 49 3000, Leuven, Belgium
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29
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Mastrobuoni S, de Kerchove L. Perceval sutureless valve and structural valve deterioration. Ann Thorac Surg 2021; 112:1381-1382. [PMID: 33567300 DOI: 10.1016/j.athoracsur.2020.10.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Stefano Mastrobuoni
- Cardiovascular and Thoracic Surgery, Saint-Luc's Hospital, Catholic University of Louvain, Avenue Hippocrate 10 1200 Brussels, Belgium.
| | - Laurent de Kerchove
- Cardiovascular and Thoracic Surgery, Saint-Luc's Hospital, Catholic University of Louvain, Avenue Hippocrate 10 1200 Brussels, Belgium
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