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Quinn RD. The 10 Commandments of Perceval Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:299-307. [PMID: 37585810 DOI: 10.1177/15569845231191525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Reed D Quinn
- Cardiovascular Surgery, Maine Medical Center, Portland, ME, USA
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Volk LE, Elkhechen J, Olds A, Lee LY. Placement of a rapid deployment aortic valve in a patient with severely calcified aortic root homograft. J Card Surg 2020; 35:706-709. [PMID: 31981433 DOI: 10.1111/jocs.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Significant aortic calcification is a known sequelae of homograft aortic root replacement and creates a treatment challenge if these patients require cardiac reintervention. The standard surgical option for patients requiring an aortic valve replacement in the setting of a calcified aortic homograft has been a Bentall procedure, which is high-risk with extended cross-clamp, cardiopulmonary bypass and operative times. We present a patient with a severely calcified aortic homograft who underwent successful valve replacement using a rapid deployment aortic valve leaving the aortic root and arch intact and avoiding the more extensive redo aortic root replacement. Similar cases in the literature are rare.
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Affiliation(s)
- Lindsay E Volk
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Justin Elkhechen
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Anna Olds
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Leonard Y Lee
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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Suri RM, Javadikasgari H, Heimansohn DA, Weissman NJ, Ailawadi G, Ad N, Aldea GS, Thourani VH, Szeto WY, Michler RE, Michelena HI, Dabir R, Fontana GP, Kessler WF, Moront MG, Brunsting LA, Griffith BP, Montoya A, Subramanian S, Mostovych MA, Roselli EE. Prospective US investigational device exemption trial of a sutureless aortic bioprosthesis: One-year outcomes. J Thorac Cardiovasc Surg 2019; 157:1773-1782.e3. [DOI: 10.1016/j.jtcvs.2018.08.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/05/2018] [Accepted: 08/14/2018] [Indexed: 11/26/2022]
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Sutureless aortic valve replacement in a calcified homograft combined with mitral valve replacement. J Cardiothorac Surg 2017; 12:82. [PMID: 28882144 PMCID: PMC5590235 DOI: 10.1186/s13019-017-0642-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022] Open
Abstract
Background Aortic valve replacement in a patient with an aortic homograft can be very challenging, especially when concomitant mitral valve surgery needs to be performed. Case presentation We report a case of implantation of a sutureless aortic valve bioprosthesis combined with mitral valve replacement in a patient with a severely calcified aortic homograft where conventional valve replacement was technically unfeasible. Conclusions We believe that sutureless AVR is a viable option especially for young patients with a high surgical risk where conventional valve replacement cannot be achieved.
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Abstract
Aortic valve replacement is no longer an operation that is approached solely through a median sternotomy. Recent advances in the fields of transcatheter valves have expanded the proportion of patients eligible for intervention. Comparisons between transcatheter valves and conventional surgery have shown non-inferiority of transcatheter valve implants in patients with a high or intermediate pre-operative predictive risk. With advances in our understanding of sutureless valves and their applicability to minimally invasive surgery, the invasiveness and trauma of surgery can be reduced with potential improvements in outcome. The strategy of care has radically changed over the last decade.
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Affiliation(s)
- Ahmed Al-Adhami
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK
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Vola M, Maureira JP, Ruggieri VG, Fuzellier JF, Campisi S, Favre JP, Gerbay A, Folliguet TA. Proof of Concept of an Endoscopic Sutureless Valve Sizer. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Vola
- Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Etienne, France
| | - Juan Pablo Maureira
- Cardiac Surgery Unit, University Hospital of Brabois, University of Lorraine, Vandoeuvre les, Nancy, France
| | | | | | - Salvatore Campisi
- Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Etienne, France
| | - Jean-Pierre Favre
- Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Etienne, France
| | - Antoine Gerbay
- Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Etienne, France
| | - Thierry A. Folliguet
- Cardiac Surgery Unit, University Hospital of Brabois, University of Lorraine, Vandoeuvre les, Nancy, France
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Proof of Concept of an Endoscopic Sutureless Valve Sizer. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:337-341. [DOI: 10.1097/imi.0000000000000313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective In this paper, we present an endoscopic expandable sizer conceived to allow thoracoscopic aortic valve replacement with a sutureless prosthesis using a dynamic sizing of the aortic annulus. Methods Ten aortic torsos were prepared using a five-trocar thoracoscopic setting. Once the aortotomy was performed and the aortic valve leaflets removed, the technical feasibility of the endoscopic sizing (introduction into the trocar, expansion into the aortic annulus, determination of the valve size, and retraction) with the device was assessed. In case of successful thoracoscopic sizing, endoscopic implantation of a sutureless valve (five LivaNova Perceval prosthesis and five Medtronic 3f Enable bioprosthesis) was performed. Before ascending aorta closure, we assessed the appropriate sealing of the bioprosthesis in the native annulus with camera visualization and a nerve hook inspection. Results All the 10 endoscopic sizings were technically feasible. The scheduled aortic sutureless valve implantations were successfully performed. In all cases, fitting and placement of the sutureless bio-prosthesis in the flaccid heart was satisfactory, with no paraprosthetic leakage detectable by the nerve hook. Conclusions The use of the endoscopic expandable sizer is technically possible. In this early-stage test in the flaccid heart, selection of the valve size was satisfactory during thoracoscopic sutureless aortic bioprosthesis implantation. Further laboratory evaluation with fluid dynamics (aortic root pressurization) will be performed before a clinical study is started.
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Edwards Intuity Aortic Bioprosthesis in Patient with Bicuspid Aortic Valve. CURRENT HEALTH SCIENCES JOURNAL 2016; 42:289-292. [PMID: 30581583 PMCID: PMC6269610 DOI: 10.12865/chsj.42.03.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/16/2016] [Indexed: 11/30/2022]
Abstract
Bicuspid aortic valve (BAV) is generally considered to be a contraindication to sutureless aortic valve replacement (AVR). Implantation of the Edwards Intuity aortic bioprosthesis is an innovative approach associated with superior hemodynamic performance, significantly reduced myocardial ischaemia and cardiopulmonary bypass times and proves to be suitable for type 1 and 2 of bicuspid aortic valves replacement. We report a case of successful AVR using a fast deployment bioprosthesis,the Edwards Intuity Valve System, in a 67-year-old woman with a bicuspid aortic valve and concomitant severe aortic stenosis.
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Lio A, Scafuri A, Nicolò F, Chiariello L. Valve Replacement with a Sutureless Aortic Prosthesis in a Patient with Concomitant Mitral Valve Disease and Severe Aortic Root Calcification. Tex Heart Inst J 2016; 43:186-8. [PMID: 27127442 DOI: 10.14503/thij-15-5152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aortic valve replacement with concomitant mitral valve surgery in the presence of severe aortic root calcification is technically difficult, with long cardiopulmonary bypass and aortic cross-clamp times. We performed sutureless aortic valve replacement and mitral valve annuloplasty in a 68-year-old man who had severe aortic stenosis and moderate-to-severe mitral regurgitation. Intraoperatively, we found severe calcification of the aortic root. We approached the aortic valve through a transverse aortotomy, performed in a higher position than usual, and we replaced the valve with a Sorin Perceval S sutureless prosthesis. In addition, we performed mitral annuloplasty with use of an open rigid ring. The aortic cross-clamp time was 63 minutes, and the cardiopulmonary bypass time was 83 minutes. No paravalvular leakage of the aortic prosthesis was detected 30 days postoperatively. Our case shows that the Perceval S sutureless bioprosthesis can be safely implanted in patients with aortic root calcification, even when mitral valve disease needs surgical correction.
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Sutureless aortic valve prosthesis in a calcified homograft. J Thorac Cardiovasc Surg 2015; 150:e29-30. [DOI: 10.1016/j.jtcvs.2015.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/01/2015] [Accepted: 04/12/2015] [Indexed: 11/22/2022]
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Permanyer E, Estigarribia AJ, Ysasi A, Herrero E, Semper O, Llorens R. The 3f Enable sutureless bioprosthesis: Early results, safeguards, and pitfalls. J Thorac Cardiovasc Surg 2015; 149:1578-83. [DOI: 10.1016/j.jtcvs.2014.10.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/24/2014] [Accepted: 10/06/2014] [Indexed: 11/15/2022]
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Di Eusanio M, Phan K. Sutureless aortic valve replacement. Ann Cardiothorac Surg 2015; 4:123-30. [PMID: 25870807 DOI: 10.3978/j.issn.2225-319x.2015.02.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 11/14/2022]
Abstract
The increasing incidence of aortic stenosis and greater co-morbidities and risk profiles of the contemporary patient population has driven the development of minimally invasive aortic valve surgery and percutaneous transcatheter aortic valve implantation (TAVI) techniques to reduce surgical trauma. Recent technological developments have led to an alternative minimally invasive option which avoids the placement and tying of sutures, known as "sutureless" or rapid deployment aortic valves. Potential advantages for sutureless aortic prostheses include reducing cross-clamp and cardiopulmonary bypass (CPB) duration, facilitating minimally invasive surgery and complex cardiac interventions, whilst maintaining satisfactory hemodynamic outcomes and low paravalvular leak rates. However, given its recent developments, the majority of evidence regarding sutureless aortic valve replacement (SU-AVR) is limited to observational studies and there is a paucity of adequately-powered randomized studies. Recently, the International Valvular Surgery Study Group (IVSSG) has formulated to conduct the Sutureless Projects, set to be the largest international collaborative group to investigate this technology. This keynote lecture will overview the use, the potential advantages, the caveats, and current evidence of sutureless and rapid deployment aortic valve replacement (AVR).
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Affiliation(s)
- Marco Di Eusanio
- 1 Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kevin Phan
- 1 Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Sutureless prostheses and less invasive aortic valve replacement: just an issue of clamping time? Ann Thorac Surg 2015; 99:1518-23. [PMID: 25757759 DOI: 10.1016/j.athoracsur.2014.12.072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/17/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recently, sutureless aortic bioprostheses have been increasingly adopted to facilitate minimally invasive aortic valve replacement. We aimed at evaluating the impact of the transition from conventional bioprostheses to the routine use of the 3f Enable prosthesis (Medtronic ATS Medical, Minneapolis, MN) for aortic valve replacement through ministernotomy. METHODS Between November 2009 and November 2012, 83 consecutive minimally invasive aortic valve replacement procedures were performed in our institution by the same surgeon through an upper T-shaped ministernotomy. The earliest 42 patients (group A) received a conventional bioprosthesis, and the later 41 patients (group B) received the sutureless 3f Enable valve. Aortic clamping and cardiopulmonary bypass times, early outcomes, and valve hemodynamics were compared. RESULTS There was no statistical intergroup difference in baseline characteristics. In-hospital mortality was 1% (a single nonvalve-related death). Average aortic clamping times in group A and group B were, respectively, 85 ± 17 and 47 ± 11 minutes (p < 0.0001); the cardiopulmonary bypass time was 108 ± 21 and 69 ± 15 minutes, respectively (p < 0.0001). There were three paravalvular leakages in group A (grade I) and four in group B (two grade I, and two grade II); three pacemaker implantations occurred in group B (p = 0.07); mean transvalvular gradient at discharge was 16.9 ± 9.1 mm Hg in group A and 11.4 ± 4.3 mm Hg in group B (p = 0.0007). During follow-up (average 25.5 ± 12.9 months), one structural valve deterioration was registered in group A, and was treated with a valve-in-valve procedure. CONCLUSIONS In our initial experience, the sutureless 3f Enable technology significantly reduced the clamping and cardiopulmonary bypass times, as well as the mean transvalvular gradient in aortic valve replacement through ministernotomy.
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Vola M, Campisi S, Anselmi A, Faure M, Fuzellier JF, Gerbay A. Video-assisted minithoracotomy approach: technical developments towards totally endoscopic sutureless aortic valve replacement. J Card Surg 2014; 29:494-6. [PMID: 24862296 DOI: 10.1111/jocs.12368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Interest in sutureless aortic bioprostheses is growing because of the potential advantages that such devices can bring in facilitating minimally invasive approaches. Video assistance can potentially enhance details of decalcification and sutureless valve sizing. We review the feasibility of sutureless aortic valve replacement (AVR) via a minimally invasive video-assisted (MIVA) right anterior minithoracotomy. METHODS Between November 2012 and November 2013, 21 patients were selected to undergo an AVR using the Enable sutureless device (Medtronic, Minneapolis, MN, USA) via a video-assisted right second space minithoracotomy. RESULTS Procedural success of the MIVA approach was 95.3% (one conversion to median sternotomy due to severe pleural adhesions). Average aortic clamp time was 72.1 ± 22.1 min. No paravalvular leakage was detected at discharge. Thirty-day mortality was 4.7% (one patient, pulmonary embolism). CONCLUSIONS The described approach appears to be safe and feasible with adequate clamp times. Video assistance allows optimal visualization of the aortic root and accurate valve delivery, without conflict between the device, the camera, and the instruments, making this setting an encouraging baseline towards the assessment of the totally endoscopic approach.
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Affiliation(s)
- Marco Vola
- Cardiovascular Surgery Unit, Saint-Etienne University Hospital, St. Etienne, France
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Santarpino G, Pfeiffer S, Concistré G, Grossmann I, Hinzmann M, Fischlein T. The Perceval S aortic valve has the potential of shortening surgical time: does it also result in improved outcome? Ann Thorac Surg 2013; 96:77-81; discussion 81-2. [PMID: 23673064 DOI: 10.1016/j.athoracsur.2013.03.083] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/16/2013] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Sutureless aortic valve prostheses have the potential of shortening surgical time. However, whether shorter operative times may also result in improved patient outcomes remains to be established. METHODS One hundred patients underwent minimally invasive isolated aortic valve replacement. Of these, 50 patients received a Perceval (Sorin Group, Saluggia, Italy) bioprosthesis (group P) and 50 patients received a non-Perceval valve (group NP). RESULTS The group P patients were older (77.5 ± 5.3 versus 71.7 ± 10 years, p = 0.001) and at higher risk (logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE] 9.9 ± 6.5 versus 4.3 ± 1, p = 0.001) than group NP patients. One implant failure occurred in group P (p = 0.5), and conversion to full sternotomy was necessary in 1 patient from each group. Aortic cross-clamp and cardiopulmonary bypass times were 39.4% and 34% shorter in group P (both p < 0.001). Within 30 days, a total of 5 patients died (2 in group P and 3 in group NP, p = 0.5). No significant differences were observed between groups in postoperative arrhythmias and need for pacemaker implantation (p = 0.3 and p = 0.5, respectively). Despite the higher surgical risk, group P patients less frequently required blood transfusion (1.1 ± 1.1 units versus 2.3 ± 2.8 units, p = 0.007), and had a shorter intensive care unit stay (1.9 ± 0.7 versus 2.8 ± 1.9 days, p = 0.002) and a shorter intubation time (9.2 ± 3.6 hours versus 15 ± 13.8 hours, p = 0.01). Group NP patients had a mean prosthesis size significantly smaller than for group P (23 ± 2 mm versus 23.9 ± 1.1 mm, p = 0.01). The Perceval valve provided comparable hemodynamic performance to that of non-Perceval valves (mean gradient 8.4 ± 6 mm Hg versus 10 ± 4.9 mm Hg, p = 0.24). CONCLUSIONS Sutureless implantation of the Perceval valve is associated with shorter cross-clamp and cardiopulmonary bypass times, resulting in improved clinical outcome. In addition, it compares favorably with conventional valves in terms of mortality and outcome variables.
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Gupta P, McCormack DJ, Szczeklik M, Ambekar S, Lall KS. Infected Calcified Homograft Root: A Sutureless Solution. Ann Thorac Surg 2013; 95:1789-91. [DOI: 10.1016/j.athoracsur.2012.09.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/11/2012] [Accepted: 09/18/2012] [Indexed: 11/29/2022]
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