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Zubarevich A, Amanov L, Arjomandi Rad A, Beltsios ET, Szczechowicz M, Osswald A, Ruhparwar A, Weymann A. Single-Center Real-World Experience with Sutureless Aortic Valve Prosthesis in Isolated and Combined Procedures. J Clin Med 2023; 12:4163. [PMID: 37373856 DOI: 10.3390/jcm12124163] [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: 04/19/2023] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Due to their favourable hemodynamic performance and the ability to enable minimally invasive access procedures, sutureless aortic valve prostheses have found their place in the armamentarium of cardiothoracic surgeons. In this study, we sought to review our institutional experience of sutureless aortic valve replacement (SU-AVR). METHODS We carried out a retrospective analysis of 200 consecutive patients who underwent an SU-AVR with a Perceval valve between December 2019 and February 2023. RESULTS The mean age of patients was 69.3 ± 8.1 years, and patients showed a moderate-risk profile with a mean logistic EuroSCORE-II of 5.2 ± 8.1%. An isolated SU-AVR was performed in 85 (42.5%) patients, concomitant CABG was performed in 75 (37.5%) and 40 patients (20%) underwent a multivalve procedure involving SU-AVR. The cardiopulmonary bypass (CPB) and cross-clamp (CC) times were 82.1 ± 35.1 and 55.5 ± 27.8 min, respectively. In-hospital, 30-day, 6-month and 1-year mortality rates were 4.5%, 6.5%, 7.5% and 8.2%, respectively. The postoperative transvalvular mean pressure gradient was 6.3 ± 1.6 mmHg and stayed stable over the follow-up time. We reported no cases of paravalvular leakage, and the incidence of stroke was 0.5%. CONCLUSIONS With their favourable hemodynamic performance and shorter CC and CPB times, sutureless aortic valve prostheses facilitate minimally invasive access surgery, being a safe and durable promising approach for the surgical AVR.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
| | - Lukman Amanov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
| | | | - Eleftherios T Beltsios
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
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Andrade M, Saraiva F, Amorim MJ, Marinho B, Cerqueira RJ, Lourenço AP, Pinho P, Almeida J, Leite-Moreira AF. Hemodynamic and clinical performance of Solo stentless bioprosthetic aortic valves. Rev Port Cardiol 2018; 37:811-818. [PMID: 30274938 DOI: 10.1016/j.repc.2017.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/25/2017] [Accepted: 11/03/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report the hemodynamic profile and short- and medium-term outcomes of Freedom Solo and Solo Smart stentless aortic valves implanted at our center. METHODS Between 2009 and 2015, all patients undergoing aortic valve replacement using Solo stentless valves at our center were enrolled. Clinical and echocardiographic follow-up was carried out six months postoperatively. Survival and major events, including structural valve deterioration and non-structural valve dysfunction, endocarditis, reoperation and stroke, were assessed through medical records or telephone interview with the referring cardiologist up to November 2015 (mean and maximum follow-up 39±22 and 78 months, respectively). RESULTS Patients' (n=345) mean age was 72±8 years, 52% were female and median euroSCORE II was 2.7 (1.5-4.7). There was no intraoperative mortality and in-hospital mortality was 2.6%. Postoperatively, mean transvalvular gradient was 11.9±4.5 mmHg and effective orifice area was 1.9±0.5 cm2. Patient-prosthesis mismatch occurred in 14% but was severe in only one patient. Cumulative survival at six years was 72%. Six patients were reoperated: three due to endocarditis, two for structural prosthesis deterioration and one because of periprosthetic fistula. Five patients suffered stroke, three had medically-treated endocarditis and one had structural valve deterioration but was not considered suitable for reoperation. None of the remainder had structural valve deterioration or non-structural valve dysfunction. CONCLUSIONS Solo stentless aortic valves are safe to implant, with promising clinical outcomes in short- and medium-term assessment. Moreover, they show an excellent hemodynamic performance: low transvalvular gradients, large effective orifice areas and low incidence of patient-prosthesis mismatch.
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Affiliation(s)
- Marta Andrade
- Department of Cardiothoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Francisca Saraiva
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Mário J Amorim
- Department of Cardiothoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Benjamim Marinho
- Department of Cardiothoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui J Cerqueira
- Department of Cardiothoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - André P Lourenço
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Department of Anesthesiology, Centro Hospitalar de São João, Porto, Portugal
| | - Paulo Pinho
- Department of Cardiothoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Jorge Almeida
- Department of Cardiothoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Adelino F Leite-Moreira
- Department of Cardiothoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
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Andrade M, Saraiva F, Amorim MJ, Marinho B, Cerqueira RJ, Lourenço AP, Pinho P, Almeida J, Leite-Moreira AF. Hemodynamic and clinical performance of Solo stentless bioprosthetic aortic valves. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sponga S, Barbera MD, Pavoni D, Lechiancole A, Mazzaro E, Valente M, Nucifora G, Thiene G, Livi U. Ten-year results of the Freedom Solo stentless heart valve: excellent haemodynamics but progressive valve dysfunction in the long term. Interact Cardiovasc Thorac Surg 2017; 24:663-669. [DOI: 10.1093/icvts/ivw391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/10/2016] [Indexed: 11/14/2022] Open
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Repossini A, Fischlein T, Santarpino G, Schäfer C, Claus B, Passaretti B, Di Bacco L, Giroletti L, Bisleri G, Muneretto C, Grubitzsch H. Pericardial Stentless Valve for Aortic Valve Replacement: Long-Term Results. Ann Thorac Surg 2016; 102:1956-1965. [DOI: 10.1016/j.athoracsur.2016.05.080] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 05/20/2016] [Indexed: 11/26/2022]
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Repossini A, Di Bacco L, Passaretti B, Grubitzsch H, Schäfer C, Claus B, Giroletti L, Folliguet T, Bisleri G, Fischlein T, Santarpino G, Di Bartolomeo R, Laborde F, Muneretto C. Early hemodynamics and clinical outcomes of isolated aortic valve replacement with stentless or transcatheter valve in intermediate-risk patients. J Thorac Cardiovasc Surg 2016; 153:549-558.e3. [PMID: 27939031 DOI: 10.1016/j.jtcvs.2016.10.086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 09/30/2016] [Accepted: 10/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. The aim of the current multi-institutional study was to compare hemodynamics of transcatheter (TAVR) and the Freedom SOLO Stentless (FS) valve in an intermediate risk population undergoing surgical aortic valve replacement. METHODS From 2010 to 2014, 420 consecutive patients underwent isolated surgical aortic valve replacement with FS and 375 patients underwent TAVR. Only patients with intermediate operative risk (Society of Thoracic Surgeons score 4-10) and small aortic annulus (≤23 mm) were included. After a propensity matched analysis 142 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated. RESULTS Mean prosthesis diameter was 22.2 ± 0.9 mm for FS and 22.4 ± 1.0 mm for TAVR. In-hospital mortality was 2.1% for FS and 6.3% for TAVR (P = .02). Postoperative FS peak gradients were 19.1 ± 9.6 mm Hg (mean 10.8 ± 5.9 mm Hg); TAVR peak gradients were 20.2 ± 9.5 mm Hg (mean 10.7 ± 6.9 mm Hg) P = .57 (P = .88). Postoperative effective orifice area was 1.93 ± 0.52 cm2 for FS and 1.83 ± 0.3 cm2 for TAVR (P = .65). There was no prostheses-patient mismatch in either group. Postoperative grade 2-3 paravalvular leak was present in 3.5% for TAVR and 0.7% for FS. Postoperative permanent pacemaker implant rate was 12% for TAVR and only 1 case (0.7%) in the FS group (P < .001). CONCLUSIONS In patients with small aortic annulus and intermediate risk, both FS and TAVR demonstrated similar excellent hemodynamic performance. TAVR demonstrated greater mortality and rates of pacemaker insertion. Further studies are warranted to validate TAVR indications in this subset of patients.
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Affiliation(s)
- Alberto Repossini
- Clinical Department of Cardiovascular Surgery, University of Brescia, Brescia, Italy.
| | - Lorenzo Di Bacco
- Clinical Department of Cardiovascular Surgery, University of Brescia, Brescia, Italy
| | | | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Schäfer
- Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Claus
- Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Giroletti
- Clinical Department of Cardiovascular Surgery, University of Brescia, Brescia, Italy
| | | | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | | | - François Laborde
- Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Claudio Muneretto
- Clinical Department of Cardiovascular Surgery, University of Brescia, Brescia, Italy
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Wollersheim LW, Li WW, Bouma BJ, Kaya A, van Boven WJ, van der Meulen J, de Mol BA. Midterm Follow-Up of the Stentless Freedom Solo Bioprosthesis in 350 Patients. Ann Thorac Surg 2016; 102:86-92. [DOI: 10.1016/j.athoracsur.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 12/02/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
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Dedeilias P, Baikoussis NG, Prappa E, Asvestas D, Argiriou M, Charitos C. Aortic valve replacement in elderly with small aortic root and low body surface area; the Perceval S valve and its impact in effective orifice area. J Cardiothorac Surg 2016; 11:54. [PMID: 27066903 PMCID: PMC4827171 DOI: 10.1186/s13019-016-0438-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study is to see how the sutureless, stentless, Perceval S aortic valves behave when implanted in elderly patients with small aortic root and the comparison with a second group of patients with similar characteristics where a conventional stented bioprosthesis was implanted. This is a prospective randomized institutional study. Methods Our material is composed from 25 patients who underwent aortic valve replacement with sutureless self-anchoring Perceval S valve implantation (LivaNova), compared with 25 patients with conventional stented biological prosthesis implanted (soprano LivaNova group). The two groups of patients have similar demographic and medical characteristics with severe aortic stenosis. The study was conducted from January 2012 to June 2014. Preoperative, intraoperative and postoperative parameters were studied in order to investigate the utility of the Perceval S valves in this group of patients. Results The Perceval S valve implantation seems to be an interesting biological valve with good hemodynamic characteristics as compared with the typical biological prosthesis providing shorter ischemia time (40 ± 5.50 min vs 86 ± 15.86 min; p < 0.001), shorter extracorporeal circulation time (73.75 ± 8.12 min vs 120.36 ± 28.31 min p < 0.001), less operation time (149.38 ± 15.22 min vs 206.64 ± 42.85 min; p < 0.001) and better postoperative recovery. The postoperative gradients were 23.5 ± 19.20 mmHg vs 24.5 ± 19.90 mmHg respectively. The postoperative effective orifice area in these two groups were respectively 1.5 =/-0.19 cm2 vs 1.1=/-0.5 cm2 (p 0.002). Among the 25 patients of the Soprano stented valve, 3 (12 %) came back in 6 months with New York Heart Association (NYHA) 3. The PPM of these patients was the cause of readmission in the Hospital required diuresis and supplementary treatment. Conclusions Aortic valve replacement with Perceval aortic valves in geriatric patients with comorbidities and small aortic annulus seems to be an alternative, safe and “fast” intervention with excellent short and mid-term results which provides a better effective orifice area.
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Affiliation(s)
- Panagiotis Dedeilias
- Cardiothoracic and Vascular Surgery Department, "Evangelismos" General Hospital of Athens, 45-47 Ipsilantou Street, Kolonaki, Athens, Greece
| | - Nikolaos G Baikoussis
- Cardiothoracic and Vascular Surgery Department, "Evangelismos" General Hospital of Athens, 45-47 Ipsilantou Street, Kolonaki, Athens, Greece.
| | - Efstathia Prappa
- Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Dimitrios Asvestas
- Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Michalis Argiriou
- Cardiothoracic and Vascular Surgery Department, "Evangelismos" General Hospital of Athens, 45-47 Ipsilantou Street, Kolonaki, Athens, Greece
| | - Christos Charitos
- Cardiothoracic and Vascular Surgery Department, "Evangelismos" General Hospital of Athens, 45-47 Ipsilantou Street, Kolonaki, Athens, Greece
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Thalmann M, Grubitzsch H, Matschke K, Glauber M, Tan E, Francois K, Amorim MJ, Hensens AG, Cesari F, Feyrer R, Diegeler A, Veit F, Repossini A. A European Multicenter Study of 616 Patients Receiving the Freedom Solo Stentless Bioprosthesis. Ann Thorac Surg 2015; 101:100-8. [PMID: 26443880 DOI: 10.1016/j.athoracsur.2015.06.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 06/20/2015] [Accepted: 06/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the safety and performance of the Freedom Solo valve in aortic valve replacement by clinical and hemodynamic outcomes. METHODS Six hundred sixteen patients underwent aortic valve replacement in 18 European centers; mean age was 74.5 ± 5.9 years, 54.1% of the patients were male, and concomitant procedures were performed in 43.2% of the patients. The majority (69%) of the implanted sizes were 23 mm and 25 mm. RESULTS At 1 year, overall survival was 94.0%, whereas freedom from valve-related death was 98.6%. There were 9 (1.5%) early (≤ 30 days) and 27 (4.4%) late (>30 days) deaths. Early and late valve-related mortality was 0.3% (n = 2) and 1.1% (n = 7), respectively. Freedom from explant was 97.6%; 10 valves were explanted for endocarditis and 4 for paravalvular leak. There were 10 (1.6%) early and 5 (0.8%) late strokes. Atrioventricular block requiring pacemaker implant occurred in 8 (1.3%) and 1 (0.2%) patients in the early and late postoperative period, respectively. Thrombocytopenia was seen in 27 cases (4.4%) in the early postoperative period. Preoperatively, 93.8% of patients were in New York Heart Association functional classes II through IV, whereas at 1 year 96.9% of patients were in New York Heart Association functional classes I and II. At 1-year follow-up, mean and peak pressure gradients were 7.2 and 14.6 mm Hg, respectively. Indexed left ventricular mass decreased by 12% from 138 g/m(2) at discharge to 122 g/m(2) at 1 year. CONCLUSIONS At 1-year follow-up after Freedom Solo implantation, we found acceptable clinical results with low mortality and morbidity and good hemodynamic performance, confirming safety and effectiveness in this multicenter experience.
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Affiliation(s)
| | | | | | | | - Erwin Tan
- Catharina Hospital, Eindhoven, The Netherlands
| | | | | | | | | | | | | | | | - Alberto Repossini
- Cardiac Surgery, University of Brescia, Spedali Civili, Brescia, Italy
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Wollersheim LW, Li WW, Bouma BJ, Repossini A, van der Meulen J, de Mol BA. Aortic Valve Replacement With the Stentless Freedom SOLO Bioprosthesis: A Systematic Review. Ann Thorac Surg 2015; 100:1496-504. [DOI: 10.1016/j.athoracsur.2015.06.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/22/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
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van der Straaten EP, Rademakers LM, van Straten AH, Houterman S, Tan MES, Soliman Hamad MA. Mid-term haemodynamic and clinical results after aortic valve replacement using the Freedom Solo stentless bioprosthesis versus the Carpentier Edwards Perimount stented bioprosthesis. Eur J Cardiothorac Surg 2015. [DOI: 10.1093/ejcts/ezv255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Stanger O, Bleuel I, Gisler F, Göber V, Reineke S, Gahl B, Aymard T, Englberger L, Carrel T, Tevaearai H. The Freedom Solo pericardial stentless valve: Single-center experience, outcomes, and long-term durability. J Thorac Cardiovasc Surg 2015; 150:70-7. [DOI: 10.1016/j.jtcvs.2015.01.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/08/2015] [Accepted: 01/24/2015] [Indexed: 11/30/2022]
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Repossini A, Bisleri G. Freedom SOLO: avoiding pitfalls to avoid premature failures? Eur J Cardiothorac Surg 2015; 49:1020. [PMID: 26094016 DOI: 10.1093/ejcts/ezv214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/18/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alberto Repossini
- Department of Cardiac Surgery, University of Brescia, Brescia, Italy
| | - Gianluigi Bisleri
- Department of Cardiac Surgery, University of Brescia, Brescia, Italy
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Stanger O, Gisler F, Londono MC. Valve-in-valve: estimating the risk of ostium obstruction in Sorin stentless valves. J Thorac Cardiovasc Surg 2015; 149:644-5. [PMID: 25726886 DOI: 10.1016/j.jtcvs.2014.09.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Olaf Stanger
- Department of Cardiovascular Surgery, Inselspital, University Hospital and University of Berne, Berne, Switzerland
| | - Fabian Gisler
- Department of Cardiovascular Surgery, Inselspital, University Hospital and University of Berne, Berne, Switzerland
| | - Martina Correa Londono
- University Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital and University of Berne, Berne, Switzerland
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Grubitzsch H, Wang S, Matschke K, Glauber M, Heimansohn D, Tan E, Francois K, Thalmann M. Clinical and haemodynamic outcomes in 804 patients receiving the Freedom SOLO stentless aortic valve: results from an international prospective multicentre study†. Eur J Cardiothorac Surg 2014; 47:e97-104. [DOI: 10.1093/ejcts/ezu471] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Partial aortic valve replacement: a new and simple approach for endocarditis. Ann Thorac Surg 2014; 98:e101-2. [PMID: 25282243 DOI: 10.1016/j.athoracsur.2014.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 11/21/2022]
Abstract
We describe the replacement of a single cusp in two patients with severe aortic regurgitation due to endocarditis with a one third stentless bioprosthesis, with excellent results in both.
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Pozzoli A, De Maat GE, Hillege HL, Boogaard JJ, Natour E, Mariani MA. Severe Thrombocytopenia and Its Clinical Impact After Implant of the Stentless Freedom Solo Bioprosthesis. Ann Thorac Surg 2013; 96:1581-6. [DOI: 10.1016/j.athoracsur.2013.06.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
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Jelenc M, Juvan KA, Medvešček NTR, Geršak B. Influence of type of aortic valve prosthesis on coronary blood flow velocity. Heart Surg Forum 2013; 16:E8-E14. [PMID: 23439362 DOI: 10.1532/hsf98.20121073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Severe aortic valve stenosis is associated with high resting and reduced hyperemic coronary blood flow. Coronary blood flow increases after aortic valve replacement (AVR); however, the increase depends on the type of prosthesis used. The present study investigates the influence of type of aortic valve prosthesis on coronary blood flow velocity. METHODS The blood flow velocity in the left anterior descending coronary artery (LAD) and the right coronary artery (RCA) was measured intraoperatively before and after AVR with a stentless bioprosthesis (Sorin Freedom Solo; n = 11) or a bileaflet mechanical prosthesis (St. Jude Medical Regent; n = 11). Measurements were made with an X-Plore epicardial Doppler probe (Medistim, Oslo, Norway) following induction of hyperemia with an adenosine infusion. Preoperative and postoperative echocardiography evaluations were used to assess valvular and ventricular function. Velocity time integrals (VTI) were measured from the Doppler signals and used to calculate the proportion of systolic VTI (SF), diastolic VTI (DF), and normalized systolic coronary blood flow velocities (NSF) and normalized diastolic coronary blood flow velocities (NDF). RESULTS The systolic proportion of the LAD VTI increased after AVR with the St. Jude Medical Regent prosthesis, which produced higher LAD SF and NSF values than the Sorin Freedom Solo prosthesis (SF, 0.41 ± 0.09 versus 0.29 ± 0.13 [P = .04]; NSF, 0.88 ± 0.24 versus 0.55 ± 0.17 [P = .01]). No significant changes in the LAD velocity profile were noted after valve replacement with the Sorin Freedom Solo, despite a significant reduction in transvalvular gradient and an increase in the effective orifice area. AVR had no effect on the RCA flow velocity profile. CONCLUSION The coronary flow velocity profile in the LAD was significantly influenced by the type of aortic valve prosthesis used. The differences in the LAD velocity profile probably reflect differences in valve design and the systolic transvalvular flow pattern.
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Affiliation(s)
- Matija Jelenc
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Totaro P, Zattera GF. Repair versus replacement of the aortic valve for the treatment of active infective endocarditis: is Sorin Solo the aortic bioprosthesis Columbus's egg? Eur J Cardiothorac Surg 2013; 43:1276. [PMID: 23277432 DOI: 10.1093/ejcts/ezs634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cuttone F, Saplacan VG, Buklas D, Massetti M. Stentless bioprosthesis for treatment of traumatic aortic valve rupture. Asian Cardiovasc Thorac Ann 2012; 20:450-1. [PMID: 22879553 DOI: 10.1177/0218492311435820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic valve rupture after blunt trauma to the chest is an infrequent complication that should be considered at the outset in examination of an accident victim. The presence of aortic regurgitation with hemodynamic instability is an indication for surgery. We implanted a stentless bioprosthesis after aortic valve rupture due to chest trauma in a 31-year-old man with schizophrenia.
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Affiliation(s)
- Fabio Cuttone
- Department of Cardiac Surgery, University Hospital (CHU), Caen, France.
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Folliguet TA, Laborde F, Zannis K, Ghorayeb G, Haverich A, Shrestha M. Sutureless perceval aortic valve replacement: results of two European centers. Ann Thorac Surg 2012; 93:1483-8. [PMID: 22541180 DOI: 10.1016/j.athoracsur.2012.01.071] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Perceval S bioprosthesis (Sorin Biomedica Cardio Srl, Sallugia, Italy) is a self-expanding valve designed to preserve aortic sinuses and sinotubular junction. We report the midterm results of a prospective, multicenter clinical study evaluating the safety and efficacy of this stented bioprosthesis in patients undergoing aortic valve replacement with or without concomitant procedures. METHODS From January 2007 to September 2011, a total of 208 high-risk patients (mean European system for cardiac operative risk evaluation: 8.7±5.3 years) received a Perceval bioprosthesis in 2 European centers. Median follow up was 10±20 months and 100% complete, and the total accumulated follow-up was 156 patient-years. Ten patients have reached a 4-year follow-up. Valve function was assessed in all patients. RESULTS Valve implantation resulted in significant improvement of patients' symptoms. Mean preoperative and postoperative gradients were 48.6±18.6 mm Hg and 10.4±4.3 mm Hg, respectively, and preoperative and postoperative mean effective orifice areas were 0.7±0.2 and 1.4±0.4 cm2. Survival at 12 months was 87.1%, success of implantation was 95%, and freedom from reoperation was 96%. In hospital mortality was 2.4%. During follow-up, 9 patients (4%) required reoperation for paravalvular regurgitation; 7 early and 2 late reoperations. Mean cross-clamp time (CCT) and extracorporeal circulation time (ECT) were, respectively, 33±14 minutes and 54±24 minutes, including 45 patients who underwent surgery through ministernotomy. Concomitant coronary bypass was done in 48 patients with mean CCT 43±13 and ECT 68±25 minutes. CONCLUSIONS Perceval sutureless is a safe bioprosthesis that can easily be implanted, including by a minimally invasive technique. It provides excellent hemodynamic with significant clinical improvement. Overall, these data confirm the safety and utility of the Perceval bioprosthesis aortic valve replacement for high-risk patients.
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Miceli A, Gilmanov D, Murzi M, Parri MS, Cerillo AG, Bevilacqua S, Farneti PA, Glauber M. Evaluation of platelet count after isolated biological aortic valve replacement with Freedom Solo bioprosthesis. Eur J Cardiothorac Surg 2012; 41:69-73. [PMID: 21664141 DOI: 10.1016/j.ejcts.2011.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The risk of thrombocytopenia in patients undergoing aortic valve replacement (AVR) with the Freedom Solo (FS) bioprosthesis is controversial. The aim of our study was to evaluate the postoperative evolution of platelet count and function after AVR in patients undergoing isolated biological AVR with FS. METHODS Between May 2005 and June 2010, 322 patients underwent isolated biological AVR. Of these, 116 patients received FS and were compared with 206 patients who received biological valves. Platelet count, mean platelet volume (MPV), and platelet distribution width (PDW) were evaluated at baseline (T0), first (T1), second (T2), and fifth (T3) postoperative days, respectively. RESULTS Overall in-hospital mortality was 1.5% with no difference between the two groups. Thirty-seven (11.5%) patients developed thrombocytopenia. FS implantation was associated with a higher incidence of thrombocytopenia compared with the control group (24.1% vs 4.4%, p<0.0001). Patients in the FS group showed a lower platelet count than the control group at T1 (99.4±38×10(3) μl(-1) vs 122.5±41.6×10(3) μl(-1), p<0.001), T2 (79.7±36.3×10(3) μl(-1) vs 122.5±43.3×10(3) μl(-1), p<0.001) and T3 (86.6±57.4×10(3) μl(-1) vs 158.4±55.8×10(3) μl(-1), p<0.001). Moreover, the FS group also had a higher MPV (11.6±0.9 fl vs 11±1 fl, p<0.001) and higher PDW (15.1±2.3 fl vs 13.9±2.1 fl, p<0.001) at T3. In a multivariable analysis, FS (p<0.0001), body surface area (p<0.0001), cardiopulmonary bypass time (p=0.003), and lower preoperative platelet counts (p=0.006) were independent predictors of thrombocytopenia. CONCLUSIONS The FS valve might increase the risk of thrombocytopenia and platelet activation, in the absence of adverse clinical events. Prospective randomized studies on platelet function need to confirm our data.
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Affiliation(s)
- Antonio Miceli
- Department of Cardiothoracic Surgery, Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy.
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Early clinical and haemodynamic results after aortic valve replacement with the Freedom SOLO bioprosthesis (experience of Italian multicenter study). Eur J Cardiothorac Surg 2012; 41:1104-10. [DOI: 10.1093/ejcts/ezr140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Repossini A, Bloch D, Muneretto C, Piccoli P, Bisleri G, Beholz S. Platelet reduction after stentless pericardial aortic valve replacement. Interact Cardiovasc Thorac Surg 2012; 14:434-8. [PMID: 22279119 DOI: 10.1093/icvts/ivr069] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of the study was to investigate the multi-factorial phenomenon of possible postoperative thrombocytopenia after aortic valve replacement (AVR) with the freedom SOLO (FS) bioprosthesis. A total of 254 patients underwent AVR with FS bioprosthesis in two cardiac surgery institutes. Platelet counts were measured preoperatively, immediately postoperatively and daily until the 11th day postoperatively. A multivariate generalized estimating equation model was applied to identify prognostic factors for whether or not patients postoperative platelet counts indicated no thrombocytopenia (platelet count >150 10(3)/mm(3)) versus at least mild thrombocytopenia (≤150 10(3)/mm(3)). Preoperatively, 11.2% of patients showed thrombocytopenia. The preoperative platelet count averaged 233.0 ± 83.2 10(3)/mm(3). The postoperative mean of platelet counts decreased daily reaching a minimum mean of 88.4 ± 58.8 10(3)/mm(3) 3 days after surgery and then started to increase, with the Day 11 postoperative mean of 173.3 ± 51.8 10(3)/mm(3). Compared with patients with no preoperative thrombocytopenia, patients with preoperative thrombocytopenia had an 8.69 increased odds of being in the group with postoperative platelet count <150 10(3)/mm(3). No major haemorrhagic or thromboembolic event was reported during hospitalization. This study shows that thrombocytopenia after the FS bioprosthesis replacement is a transient postoperative phenomenon, largely resolved within a few days after surgery, with no clinical consequences and haemodynamic dysfunction.
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Affiliation(s)
- Alberto Repossini
- Department of Cardiac Surgery, University of Brescia, Brescia, Italy.
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The Sorin Freedom Stentless Pericardial Valve: Clinical and Echocardiographic Performance at 10 years. Int J Artif Organs 2012; 35:481-8. [DOI: 10.5301/ijao.5000103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2012] [Indexed: 11/20/2022]
Abstract
Objective: The Sorin Pericarbon Freedom (SPF) is a stentless valve made of pericardium clinically available in 1990. We report the clinical and hemodynamic performance of the SPF at 10 years. Methods: From April 2000 to December 2005, 85 patients with a mean age of 75 ± 6 years (range 57–86), underwent aortic valve replacement (AVR) with an SPF. Mean left ventricular ejection fraction was 58 ± 10% (range 29–86%) and mean peak transvalvular gradient (PG) 86 ± 24 mm Hg. Clinical evaluation was performed at 3, 6, 12 months, and yearly thereafter. Results: There were 2 operative deaths (2.4%). Follow-up ranged from 2 to 135 months (mean 78 ± 32 months) and was 99% complete. There were 35 late deaths, 7 of which were valve-related, with an actuarial survival of 45 ± 8% at 10 years. Structural SPF deterioration occurred in 2 patients, with an actuarial freedom of 96 ± 3%. A total of 4 patients were re-operated, 2 because of structural deterioration, 1 because of endocarditis, and 1 because of sinotubular junction dilatation; freedom from reoperation was 93 ± 4% at 10 years. At last clinical control, 41 patients (89%) were in NYHA class I or II. Mean SPF effective orifice area varied from 1.55 ± 0.66 cm2 for size 21 mm to 2.33 ± 0.86 cm2 for size 27 mm; PG varied from 19 ± 10 mm Hg for size 21 mm to 11 ± 6 mm Hg for size 27 mm. Left ventricular mass index decreased from 213 ± 51 gm/m2 to 157 ± 436 gm/m2 (p<0.001). Conclusions: The SPF has demonstrated overall good results in terms of valve durability and freedom from valve-related complications up to 10 years, with excellent hemodynamic performance.
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Funder JA. Current status on stentless aortic bioprosthesis: a clinical and experimental perspective. Eur J Cardiothorac Surg 2011; 41:790-9. [DOI: 10.1093/ejcts/ezr141] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Permanyer E, Ginel A, Muñoz-Guijosa C, Padró JM. The Sorin Freedom SOLO stentless aortic valve: easier implantation technique with potentially less risk of complications. Eur J Cardiothorac Surg 2011; 40:1263-4. [PMID: 21459594 DOI: 10.1016/j.ejcts.2011.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 02/19/2011] [Accepted: 02/24/2011] [Indexed: 10/18/2022] Open
Abstract
Aortic valve replacement by bioprosthesis is increasingly being used. Among these, stentless bioprosthesis is becoming a valid choice due to its potential hemodynamic improvement. The Sorin Freedom SOLO stentless aortic valve (FS) (Sorin Biomedica Cardio, Saluggia, Italy) is widely used, with initial and midterm promising results. It is designed to be deployed in a straightforward manner in the supraannular position with a single running suture due to its reproducible implantation technique. Few specific valve-related complications, such as transient thrombocytopenia or rare thrombotic events, are known. Our experience, after the implantation of 33 Freedom SOLO, suggests that using the classical implantation technique, the noncoronary sinus adopts a conformation that increases the difficulty of the implant. Besides, it could also be distorted increasing the risk of periprosthetic leakage and hypothetically becoming the origin of thrombus. We present an easy and safe variation in the implantation technique of the FS that decreases the technical difficulty of the implantation, reduces the risk of periprosthetic leakage, and may additionally reduce the risk of thrombosis.
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Affiliation(s)
- Eduard Permanyer
- Department of Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Calle Mas Casanovas 90, 08041 Barcelona, Spain.
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Giordano V, Hermens JAJM, Wajon EMCJ, Grandjean JG. Rare prosthesis failure after aortic valve replacement with a Freedom Solo. Interact Cardiovasc Thorac Surg 2010; 12:273-5. [PMID: 21044971 DOI: 10.1510/icvts.2010.249656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report an unusual case of a 78-year-old man readmitted to our Cardiac Surgery Division due to a severe regurgitation of the stentless bioprosthesis Freedom Solo implanted, strictly following the manufacturer's recommendations, approximately six months before for aortic stenosis of native valve. Although different possible etiologies may be determined for the subacute aortic regurgitation of a bioprosthesis, a partial adhesion of a leaflet to the aortic wall represents an exceptional event. The device was explanted, a new different bioprosthesis model was implanted and the patient recovered uneventfully. But no evidence of aortic or leaflet vegetations suggesting for abscess was found, neither atheromatous or calcified plaques, nor signs of inflammation of the aortic wall were detected. In the end, it is believed that the cause of the cuspal adhesion to the aortic sinus was primary tissue failure.
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Affiliation(s)
- Vincenzo Giordano
- Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, Enschede 7500 KA, The Netherlands.
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Karimov JH, Cerillo AG, Gasbarri T, Solinas M, Bevilacqua S, Glauber M. Stentless Aortic Valve Implantation through an Upper Manubrium-Limited V-Type Ministernotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010. [DOI: 10.1177/155698451000500515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jamshid H. Karimov
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, G. Monasterio Foundation, National Research Council, Massa, Italy
| | - Alfredo Giuseppe Cerillo
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, G. Monasterio Foundation, National Research Council, Massa, Italy
| | - Tommaso Gasbarri
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, G. Monasterio Foundation, National Research Council, Massa, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, G. Monasterio Foundation, National Research Council, Massa, Italy
| | - Stefano Bevilacqua
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, G. Monasterio Foundation, National Research Council, Massa, Italy
| | - Mattia Glauber
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, G. Monasterio Foundation, National Research Council, Massa, Italy
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Stentless Aortic Valve Implantation through an Upper Manubrium-Limited V-Type Ministernotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010; 5:378-80. [DOI: 10.1097/imi.0b013e3181f9f6e3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this piece of work, we attempt to highlight our approach and early experience with minimally invasive aortic valve replacement with aortic Freedom Solo stentless bioprosthesis performed through an upper manubrium-limited ministernotomy in the second intercostal space. The novel suturing technique is required for stentless aortic bioprosthesis implantation, and this, in its turn, will predetermine and influence the surgeon's choice for operative access. In our department, the feasibility of the approach was first assessed; aortic valve was replaced by stentless bioprosthesis in a total of 23 patients (mean age 57 ± 12 years). In all cases, a cardiopulmonary bypass was established by a central ascending aorta cannulation and peripheral percutaneous venous cannula insertion. This approach was found to be technically reproducible and safe. The surgical technique used is described in this article.
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Funder JA, Ringgaard S, Frost MW, Wierup P, Klaaborg KE, Hjortdal V, Nygaard H, Hasenkam JM. Aortic root distensibility and cross-sectional areas in stented and subcoronary stentless bioprostheses in pigs☆. Interact Cardiovasc Thorac Surg 2010; 10:976-80. [DOI: 10.1510/icvts.2009.230771] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Folliguet T, Dibie A, Laborde F. Future of cardiac surgery: minimally invasive techniques in sutureless valve resection. Future Cardiol 2009; 5:443-52. [DOI: 10.2217/fca.09.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aortic valve replacement with mechanical or biological heart valves is the treatment of choice for aortic valve stenosis when it is symptomatic or with severe aortic stenosis (≤ 0.6 cm2/m2) or with left ventricular dysfunction. In an effort to improve the outcomes of patients with stented biological valves, stentless valves were introduced to clinical practices in the early 1990s. Theses valves were designed to be less obstructive, and thus result in a lower transvalvular gradient. Technically the implantations of these valves are more demanding resulting in longer cross clamp and bypass times. However, important comorbid conditions in elderly patients referred for aortic valve replacement require alternative treatment options with possible reductions of the extracorporeal bypass time and reliable hemodynamic features. In order to comply with these requirements, percutaneous valves and sutureless surgical valves have been developed. The percutaneous technique has the advantage of being performed without circulatory bypass but leaving the aortic calcifications in place, thereby resulting in a high degree of paravalvular insufficiency, atrioventricular block and strokes. The surgical approach has the advantage of removing all calcifications and the valves can be optimally implanted, resulting in minimal paravalvular leak with a low incidence of atrioventricular block and strokes; however, it requires cardiopulmonary bypass. In addition, it can be performed with a low mortality (<3% in isolated aortic replacement, even in older patients). This article reviews the various techniques, strength and limitations of these sutureless valves implanted in the aortic position.
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Affiliation(s)
- Thierry Folliguet
- Department of Cardiovascular Surgery, L’institut Mutualiste Montsouris, 42 Boulevard Jourdan, Paris 75014, France
| | - Alain Dibie
- L’institut Mutualiste Montsouris, 42 Boulevard Jourdan, Paris 75014, France
| | - François Laborde
- L’institut Mutualiste Montsouris, 42 Boulevard Jourdan, Paris 75014, France
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Cattaneo P, Bruno VD, Mariscalco G, Marchetti P, Ferrarese S, Salerno-Uriarte J, Sala A. Early Hemodynamic Results of the Shelhigh SuperStentless Aortic Bioprostheses. J Card Surg 2007; 22:379-84. [PMID: 17803572 DOI: 10.1111/j.1540-8191.2007.00430.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stentless valves have been demonstrated excellent hemodynamic performances favoring the recovery of left ventricular function and the ventricular hypertrophy regression. The aim of the study was to evaluate the early hemodynamic performance of the Shelhigh SuperStentless aortic valve (AV). METHODS Between July 2003 and June 2005, 35 patients (18 females; age 70.8 +/- 11.7 years, range: 22-85) underwent AV replacement with the Shelhigh SuperStentless bioprostheses. Most recurrent etiology was senile degeneration in 25 (71%) patients and 24 (69%) were in New York Heart Association (NYHA) functional class III or IV. Concomitant coronary artery bypass grafting was performed in nine patients (25.7%) and mitral valve surgery in two patients (5.7%). Doppler echocardiography was performed before surgery, at six-month and one-year follow-up. RESULTS There were no hospital deaths and no valve-related perioperative complications. During one-year follow-up, no endocarditis or thromboembolic events were registered, no cases of structural dysfunction or valve thrombosis were noted. Mean and peak transvalvular gradients significantly decrease after AV replacement, with an evident reduction to approximately 50% of the preoperative values at six months. A 20% reduction was also observed for left ventricular mass (LVM) index at six months, with a further regression at one year. Correspondingly, significant increases in effective orifice area (EOA) and indexed EOA were determined after surgery (0.87 +/- 0.14 versus 1.84 +/- 0.29 cm2 and 0.54 +/- 0.19 versus 1.05 +/- 0.20 cm2/m2, respectively). Valve prosthesis-patient mismatch was moderate in five patients and severe in one case. CONCLUSIONS Shelhigh SuperStentless AV provided good and encouraging hemodynamic results. Long-term follow-up is necessary to evaluate late hemodynamic performance and durability of this stentless bioprosthesis.
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Affiliation(s)
- Paolo Cattaneo
- Department of Cardiology and Cardiac Rehabilitation Clinical Institute Multimedica Holding Santa Maria, Castellanza, Varese, and Multimedica Sesto San Giovanni, Milano, Italy
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Glauber M, Solinas M, Karimov J. Technique for implant of the stentless aortic valve Freedom Solo. Multimed Man Cardiothorac Surg 2007; 2007:mmcts.2007.002618. [PMID: 24415056 DOI: 10.1510/mmcts.2007.002618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this presentation we provide a summary of aortic valve replacement with a supra-annular stentless aortic valve, the Freedom Solo prosthesis. Stentless valves were designed to provide more physiological flow and lower transvalvular gradient, which is offered by the novel design of the valve and by its implantation technique. The supra-annular stentless aortic valve implantation is demonstrated with a special emphasis on its surgical technique peculiarities.
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Affiliation(s)
- Mattia Glauber
- CNR Institute of Clinical Physiology 'G. Pasquinucci' Hospital, Via Aurelia Sud, 54100 Massa, Italy
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