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Asta L, Sbrigata A, Pisano C. Sutureless Aortic Prosthesis Valves versus Transcatheter Aortic Valve Implantation in Intermediate Risk Patients with Severe Aortic Stenosis: A Literature Review. J Clin Med 2024; 13:5592. [PMID: 39337078 PMCID: PMC11433614 DOI: 10.3390/jcm13185592] [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: 07/09/2024] [Revised: 08/31/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024] Open
Abstract
Aortic stenosis remains the most frequently occurring valvular pathology in the elderly population of Western countries. According to the latest guidelines, the therapeutic choice of aortic stenosis depends on the age of the patient (<75 years or >75 years) and the risk class (STS-Prom/Euroscore II < o >4%). Therefore, if the surgical indication is clear in young and low-risk patients and percutaneous treatment is the gold standard in older and high-risk patients, the therapeutic choice is still debated in intermediate-risk patients. In this group of patients, aortic valve stenosis treatment depends on the patient's global evaluation, the experience of the center, and, no less importantly, the patient's will. Two main therapeutic options are debated: surgical aortic valve replacement with sutureless prosthesis versus transcatheter aortic valve implantation. In addition, the progressive development of mininvasive techniques for aortic valve surgery (right-anterior minithoracotomy) has also reduced the peri- and post-operative risk in this group of patients. The purpose of this review is to compare sutureless aortic valve replacement (SuAVR) versus TAVI in intermediate-risk patients with severe aortic stenosis.
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Affiliation(s)
- Laura Asta
- Department of Cardiac Surgery, Clinical Mediterranean, 80122 Naples, Italy;
| | - Adriana Sbrigata
- Cardiac Surgery Unit, Department of Precision Medicine in Medical Surgical and Critical Area (Me.Pre.C.C.), University of Palermo, 90134 Palermo, Italy;
| | - Calogera Pisano
- Cardiac Surgery Unit, Department of Precision Medicine in Medical Surgical and Critical Area (Me.Pre.C.C.), University of Palermo, 90134 Palermo, Italy;
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Spadaccio C, Nenna A, Pisani A, Laskawski G, Nappi F, Moon MR, Biancari F, Jassar AS, Greason KL, Shrestha ML, Bonaros N, Rose D. Sutureless Valves, a "Wireless" Option for Patients With Aortic Valve Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:382-407. [PMID: 39019533 DOI: 10.1016/j.jacc.2024.05.031] [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: 01/03/2024] [Revised: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 07/19/2024]
Abstract
Transcatheter technologies triggered the recent revision of the guidelines that progressively widened the indications for the treatment of aortic stenosis. On the surgical realm, a technology avoiding the need for sutures to anchor the prosthesis to the aortic annulus has been developed with the aim to reduce the duration of cardiopulmonary bypass and simplify the process of valve implantation. In addition to a transcatheter aortic valve replacement (TAVR)-like stent that exerts a radial force, these so-called "rapid deployment valves" or "sutureless valves" for aortic valve replacement also have cuffs to improve sealing and reduce the risk of paravalvular leak. Despite promising, the actual advantage of sutureless valves over traditional surgical procedures (surgical aortic valve replacement) or TAVR is still debated. This review summarizes the current comparative evidence reporting outcomes of "sutureless valves" for aortic valve replacement to TAVR and surgical aortic valve replacement in the treatment of aortic valve stenosis.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom; Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Antonio Nenna
- Cardiovascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Angelo Pisani
- Cardiac Surgery, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Grzegorz Laskawski
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Marc R Moon
- Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, Texas, USA
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital/University of Helsinki, Helsinki, Finland
| | - Arminder S Jassar
- Cardiac Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - Kevin L Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Malakh L Shrestha
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA; Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany
| | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - David Rose
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
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Caruso V, Bilkhu R, Young C, Roxburgh J, Bosco P, Lucchese G. Novel Techniques and Technologies for Surgical Aortic Valve Replacement: A Large Retrospective Cohort Analysis. J Clin Med 2024; 13:4126. [PMID: 39064166 PMCID: PMC11278247 DOI: 10.3390/jcm13144126] [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: 06/09/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: In an era of growing evidence for transaortic valve implantation (TAVI), our research topic was the evaluation of how surgical aortic valve replacements (SAVRs) are performing in terms of short- and long-term outcomes in different risk categories. Methods: This was a single centre, prospective, and observational cohort study of consecutive patients with aortic valve stenosis, undergoing isolated aortic valve replacement using a biological or mechanical prosthesis, Freestyle™ (Medtronic, Minneapolis, MN, USA) graft, homograft, or Ross procedure. The participant data were collected by review of an internal database. The primary endpoints were all-cause operative mortality (in hospital and at 30 days) and late mortality at the follow-up date. The secondary composite endpoint was the incidence of postoperative complications. Results: 1501 patients underwent SAVR; the mean age was 67 years (SD: 12.6). The in-hospital mortality was 1% (n = 16). At a median follow-up of 60 months, the survival rate was 98.7%. The main predictors for mortality were operative urgency and cardiogenic shock. The overall incidence of PPM was 2.3% (n = 34). Patients who underwent Ross procedure were younger (mean age: 20 years (SD: 1.7)), had a lower incidence of postoperative complications, and were all alive at follow-up. Conclusions: SAVR shows an excellent survival rate and a low rate of postoperative complications despite an increasing surgical risk. Recent advancements in technology, like sutureless/rapid deployment prostheses and minimally invasive techniques, are shown to have favourable effects on outcomes.
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Affiliation(s)
- Vincenzo Caruso
- Cardiovascular Department, St. Thomas’ Hospital, London SE1 7EH, UK; (R.B.); (C.Y.); (J.R.); (P.B.); (G.L.)
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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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Jayet A, Lu H, Monney P, Verdugo-Marchese M, Gunga Z, Rancati V, Ltaief Z, Kirsch M. Thrombocytopenia among Patients Undergoing Aortic Valve Replacement Using the Sutureless Perceval S Bioprosthesis: A Retrospective Study. J Clin Med 2024; 13:1083. [PMID: 38398396 PMCID: PMC10888618 DOI: 10.3390/jcm13041083] [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: 01/08/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The sutureless Perceval S bioprosthesis is associated with postoperative thrombocytopenia. Our objectives were to compare the incidence, severity, and clinical implications of thrombocytopenia after aortic valve replacement (AVR) using the Perceval S or the Trifecta bioprosthesis. METHODS Patients who underwent AVR between March 2016 and August 2019 using the Perceval or Trifecta were retrospectively included. The primary endpoint was the nadir in platelet counts within 15 days after surgery. Secondary endpoints included postoperative hemolysis and inflammatory parameters, as well as clinical and echocardiographic outcomes. RESULTS Overall, 156 patients were included (Perceval, n = 103; Trifecta, n = 53). Preoperatively, there was no difference in platelet counts between the two groups. Postoperatively, the Perceval S bioprosthesis was associated with a greater decrease in platelet counts. The nadir was reached at Day 3 for both groups, but thrombocytopenia was more severe for the Perceval S (Perceval S vs. Trifecta, 89.2 ± 37.7 × 109/L vs. 106.5 ± 34.1 × 109/L, p = 0.01). No difference regarding lactate dehydrogenase, C-reactive protein, and white blood cells count was found. All-cause 30-day mortality rates (both valves, 2%, p = 0.98), hospital lengths of stay, and re-operation rates were similar. CONCLUSION The Perceval S bioprosthesis was associated with more severe postoperative thrombocytopenia. This did not translate into higher short-term morbidity or mortality.
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Affiliation(s)
- Adrien Jayet
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
| | - Henri Lu
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (H.L.)
| | - Pierre Monney
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (H.L.)
| | - Mario Verdugo-Marchese
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
| | - Ziyad Gunga
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
| | - Valentina Rancati
- Department of Anaesthesiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Zied Ltaief
- Adult Intensive Care Unit, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Matthias Kirsch
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
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Angellotti D, Manzo R, Castiello DS, Immobile Molaro M, Mariani A, Iapicca C, Nappa D, Simonetti F, Avvedimento M, Leone A, Canonico ME, Spaccarotella CAM, Franzone A, Ilardi F, Esposito G, Piccolo R. Hemodynamic Performance of Transcatheter Aortic Valves: A Comprehensive Review. Diagnostics (Basel) 2023; 13:diagnostics13101731. [PMID: 37238215 DOI: 10.3390/diagnostics13101731] [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: 03/26/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a widely adopted treatment option for patients with severe aortic stenosis. Its popularity has grown significantly in recent years due to advancements in technology and imaging. As TAVI use is increasingly expanded to younger patients, the need for long-term assessment and durability becomes paramount. This review aims to provide an overview of the diagnostic tools to evaluate the hemodynamic performance of aortic prosthesis, with a special focus on the comparison between transcatheter and surgical aortic valves and between self-expandable and balloon-expandable valves. Moreover, the discussion will encompass how cardiovascular imaging can effectively detect long-term structural valve deterioration.
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Affiliation(s)
- Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | | | | | - Andrea Mariani
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Cristina Iapicca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Dalila Nappa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | | | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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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] [MESH Headings] [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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Ferreira R, Rua N, Sena A, Velho TR, Gonçalves J, Junqueira N, Almeida AG, Nobre Â, Pinto F. Sutureless bioprosthesis for aortic valve replacement: Surgical and clinical outcomes. J Card Surg 2022; 37:4774-4782. [PMID: 36335595 PMCID: PMC10099473 DOI: 10.1111/jocs.17113] [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: 06/17/2022] [Revised: 10/15/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aortic valve stenosis is the most common adult valve disease in industrialized countries. The aging population and the increase in comorbidities urge the development of safer alternatives to the current surgical treatment. Sutureless bioprosthesis has shown promising results, especially in complex procedures and in patients requiring concomitant surgeries. OBJECTIVES Assess the clinical and hemodynamic performance, safety, and durability of the Perceval® prosthetic valve. METHODS This single-center retrospective longitudinal cohort study collected data from all adult patients with aortic valve disease who underwent aortic valve replacement with a Perceval® prosthetic valve between February 2015 and October 2020. Of the 196 patients included (mean age 77.20 ± 5.08 years; 45.4% female; mean EuroSCORE II 2.91 ± 2.20%), the majority had aortic stenosis. RESULTS Overall mean cross-clamp and cardiopulmonary bypass times were 33.31 ± 14.09 min and 45.55 ± 19.04 min, respectively. Mean intensive care unit and hospital stay were 3.32 ± 3.24 days and 7.70 ± 5.82 days, respectively. Procedural success was 98.99%, as two explants occurred. Four valves were reimplanted due to intraoperative misplacement. Mean transvalvular gradients were 7.82 ± 3.62 mmHg. Pacemaker implantation occurred in 12.8% of patients, new-onset atrial fibrillation in 21.9% and renal replacement support was necessary for 3.1%. Early mortality was 2.0%. We report no structural valve deterioration, strokes, or endocarditis, and one successfully treated valve thrombosis. CONCLUSIONS Our study confirms the excellent clinical and hemodynamic performance and safety of a truly sutureless aortic valve, up to a 5-year follow-up. These results were consistent in isolated and concomitant interventions, solidifying this device as a viable option for the treatment of isolated aortic valve disease.
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Affiliation(s)
- Ricardo Ferreira
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nuno Rua
- Faculdade de Ciências Médicas da Universidade da Beira Interior, Covilhã, Portugal
| | - André Sena
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Tiago R Velho
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - João Gonçalves
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Nádia Junqueira
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Ana G Almeida
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Ângelo Nobre
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Fausto Pinto
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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Krasivskyi I, Djordjevic I, Ivanov B, Gerfer S, Suhr L, Avgeridou S, Sabashnikov A, Kuhn E, Rahmanian P, Mader N, Eghbalzadeh K, Wahlers T. High Incidence of Transient Permanent Pacemaker Rate After Rapid Deployment Valve Replacement: Insights of a 9-Year Single-Centre Experience. Heart Lung Circ 2022; 31:1658-1665. [PMID: 36155721 DOI: 10.1016/j.hlc.2022.08.003] [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: 06/16/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The incidence of new permanent pacemaker implantation (PPI) after rapid deployment aortic valve replacement (RDAVR) remains debated. Expertise in this field has significantly increased over the last decade. This study aimed to investigate the need for PPI following implantation of a rapid deployment (RD) valve. METHODS Analysis of n=372 patients who underwent Edwards INTUITY (Edwards Lifesciences, Irvine, CA, USA) (n=251) and Perceval (Sorin/LivaNova Group, Saluggia, Italy) (n=121) valve replacement at the current institution between May 2012 and August 2018 was performed. Coronary artery bypass graft procedures were additionally performed in patients with coronary artery disease. Baseline, preoperative and postoperative outcomes were examined regarding correctness and completeness of the procedure. Statistical analysis was performed using SPSS Version 23.0.0 (IBM Corp, Armonk, NY, USA). RESULTS A total of 372 patients (aged 75±6.3 yrs) with a high grade of aortic valve stenosis underwent either Edwards INTUITY (67%) or Perceval (33%) valve replacement. Seventy-six (76) patients (20%) presented with preoperative conduction disorders. Sixty (60) patients (16%) underwent PPI, which in most cases was performed during the first month after the initial operation. Follow-up was performed up to 9 years, presenting a persistent pacemaker dependency rate of 50% among all patients who underwent PPI. Twenty (20) (40%) PPI recipients showed no dependency on pacemaker, while 10 (10%) required temporary pacemaker support. Mean length of ICU stay was 4±5.1 days and in-hospital stay was 8.2±7.6 days. CONCLUSIONS The incidence of PPI after RD valve implantation still remains high compared with conventional aortic valve replacement. However, this study shows that this phenomenon appears to be transient in a significant proportion of the patients undergoing RD valve replacement. These findings might contribute to the scientific discussion and should be taken into consideration for the indication of RD valve replacement.
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Affiliation(s)
- Ihor Krasivskyi
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany.
| | - Ilija Djordjevic
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Borko Ivanov
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Stephen Gerfer
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Laura Suhr
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Soi Avgeridou
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Anton Sabashnikov
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Elmar Kuhn
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Parwis Rahmanian
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Navid Mader
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Kaveh Eghbalzadeh
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Thorsten Wahlers
- University Hospital Cologne, Heart Center Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
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Makhdoum A, Kim K, Koziarz A, Reza S, Alsagheir A, Pandey A, Teoh K, Alhazzani W, Lamy A, Yanagawa B, Belley-Cote EP, Whitlock R. A survey of cardiac surgeons to evaluate the use of sutureless aortic valve replacement in Canada. J Card Surg 2022; 37:3543-3549. [PMID: 35998278 DOI: 10.1111/jocs.16839] [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: 06/27/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SuAVR) is gaining popularity for the treatment of aortic stenosis. We aimed to describe Canadian cardiac surgeons' practice patterns and perceptions regarding SuAVR. METHODS Content experts (clinicians and methodologists) developed the survey. Domains in the questionnaire include: respondent characteristics, factors influencing the decision to implant a SuAVR, barriers to SuAVR use, and interest in participating in a trial. RESULTS A total of 66 cardiac surgeons (median duration of practice: 15 years; range 8-20 years) from 18 hospitals across Canada responded to the survey for a response rate of 84%. Surgeons reported that the following patient characteristics increased the likelihood they would choose SuAVR: hostile root (73%), small annular size (55%), high Society of Thoracic Surgery risk score (42%), older age (40%), to support minimally invasive surgery (25%) and redo-operation (23%). The following patient characteristics made surgeons less likely to pursue SuAVR: young age (73%), low STS score (40%), and large annular size (30%). Reported barriers to SuAVR use included: cost (33%), permanent pacemaker risk (27%) and uncertain durability (12%). Of respondents, 73% were interested in participating in a randomized controlled trial comparing SuAVR with transcatheter aortic valve replacement. CONCLUSIONS The primary reasons for surgeons selecting SuAVR were high surgical risk and anatomical challenges. Cost is a primary factor limiting SuAVR use.
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Affiliation(s)
- Ahmad Makhdoum
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Kevin Kim
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alex Koziarz
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Seleman Reza
- Population Research Health Institute, McMaster University, Hamilton, Canada
| | - Ali Alsagheir
- Population Research Health Institute, McMaster University, Hamilton, Canada
| | - Arjun Pandey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Teoh
- Southlake Regional Health Sciences Centre, Newmarket, Ontario, Canada
| | - Waleed Alhazzani
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andre Lamy
- Population Research Health Institute, McMaster University, Hamilton, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Emilie P Belley-Cote
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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11
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Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070979. [PMID: 35888069 PMCID: PMC9316623 DOI: 10.3390/life12070979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The rapid development of transcatheter treatment methods has made transcatheter aortic valve replacement (TAVR) a feasible alternative to conventional surgical aortic valve replacement (SAVR). Recently, indications for TAVR have been expanded to intermediate- and low-risk patients, although there still remains a portion of ineligible patients. We sought to evaluate and compare our experience with sutureless SAVR and transapical TAVR in the "grey-area" of patients unsuitable for transfemoral access. METHODS Between April 2018 and June 2021, 248 consecutive patients underwent a sutureless SAVR (SU-SAVR) or TA-TAVR at our institution. We performed a pair-matched analysis and identified 56 patient pairs based on the EuroSCORE II. All transcatheter procedures were performed using SAPIEN XT/3™ prostheses, while all surgical procedures deployed the Perceval (LivaNova) aortic valve. RESULTS All patients presented with multiple comorbidities as reflected by the median EuroSCORE-II of 3.1% (IQR 1.9-5.3). Thirty-four patients from the surgical group (60.7%) underwent a concomitant myocardial revascularization. There was no significant difference in major adverse events, pacemaker implantation or postoperative mortality during follow-up. Both interventions demonstrated technical success with similar mean postoperative pressure gradients at follow-up and no cases of paravalvular leakage. CONCLUSIONS Sutureless aortic valve replacement constitutes a feasible treatment alternative for patients with aortic valve disease who are ineligible for transfemoral access route and/or require concomitant coronary revascularization. With its excellent hemodynamic performance, similar survival compared to TA-TAVR, and high cost-efficiency without compromising the postoperative outcomes and in-hospital length of stay SU-AVR might be considered for patients in the "grey-area" between TAVR and SAVR.
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12
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Comparison of Sutureless Bioprosthetic Valve With Surgical or TAVR for Severe Aortic Stenosis. JACC: ASIA 2021; 1:317-329. [PMID: 36341221 PMCID: PMC9627931 DOI: 10.1016/j.jacasi.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/21/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Background Clinical advantages of sutureless rapid-deployment (RD) aortic valve replacement (AVR) for severe aortic valve stenosis (AS) have not been elucidated compared with surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. Objectives This study sought to investigate comparative effectiveness and safety of RD-AVR compared with SAVR and TAVR in a prospective cohort of patients with severe AS. Methods The primary outcome was a composite of death, stroke, or rehospitalization at 12 months. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. Results Among 1,020 eligible patients, 107 (10.5%) underwent RD-AVR, 437 (42.8%) underwent SAVR, and 476 (46.7%) underwent TAVR. In the matched cohorts of RD-AVR and SAVR (n = 107), the incidence of primary composite outcome at 12 months was similar between the 2 groups (8.0% vs 10.8%, respectively; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.30-1.84; P = 0.52). In the matched cohorts of RD and TAVR (n = 58), the incidence of primary composite outcome at 12 months did not statistically differ between the 2 groups (9.4% vs 16.2%, respectively; HR: 0.53; 95% CI: 0.18-1.57; P = 0.25). Conclusions In this propensity-matched cohort of patients who underwent AVR for severe AS, we did not detect significant differences in the rates of the primary composite of death, stroke, or rehospitalization at 12 months when comparing RD-AVR with SAVR and TAVR. Because the study was underpowered, the results should be considered as hypothesis generating highlighting the need for further research. (ASAN Medical Center Aortic Valve Replacement Registry [ASAN-AVR]; NCT03298178)
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13
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Kim KS, Makhdoum A, Koziarz A, Gupta S, Alsagheir A, Pandey A, Reza S, Um K, Teoh K, Alhazzani W, Lamy A, Yanagawa B, Belley-Côté EP, Whitlock RP. Outcomes of sutureless aortic valve replacement versus conventional aortic valve replacement and transcatheter aortic valve replacement, updated systematic review, and meta-analysis. J Card Surg 2021; 36:4734-4742. [PMID: 34617322 DOI: 10.1111/jocs.16044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/26/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SuAVR) is an alternative to surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study compares the effectiveness of SuAVR to SAVR and TAVR. METHODS We searched MEDLINE and EMBASE from inception to July 2021 for studies evaluating SuAVR, SAVR, and TAVR in adults with aortic stenosis. We performed screening, full-text assessment, data collection, and risk of bias evaluation independently and in duplicate. We evaluated risk of bias using by Cochrane and CLARITY's tools, and certainty in evidence using the GRADE framework. Data were pooled using a random-effects model. RESULTS We identified one randomized and 78 observational studies (n = 60,689; SuAVR vs. SAVR = 39,171, vs. TAVR = 21,518). All studies were at high or unclear risk of bias, with very-low certainty in effect estimates. Compared to TAVR, SuAVR demonstrates no significant difference in mortality at 30-days (odds ratio [OR]: 0.52, 95% confidence interval [CI: 0.85, 1.16], I2 = 0%), but decreased odds at 2-years (OR: 0.39, 95% CI [0.17, 0.88], I2 = 0%). SuAVR also reduced odds of mild paravalvular regurgitation (OR: 0.11, 95% CI [0.06, 0.21], I2 = 50%). Compared to SAVR, SuAVR was associated with a similar mortality at 30-days (OR: 0.99, 95% CI [0.85, 1.16], I2 = 0%) and 2-years (OR: 0.99, 95% CI [0.43-2.30], I2 = 7%). SuAVR significantly increased odds of permanent pacemaker implantation (OR: 2.5, 95% CI [2.25, 2.77], I2 = 0%). Pooled effect estimates were consistent with results from the randomized trial comparing SuAVR and SAVR. CONCLUSION Based on very-low quality evidence, SuAVR is associated with similar short- and midterm outcomes compared to TAVR and SAVR. Comparative randomized data with long-term follow-up are required to clarify the role of SuAVR.
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Affiliation(s)
- Kevin S Kim
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Ahmad Makhdoum
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Alex Koziarz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ali Alsagheir
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arjun Pandey
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Seleman Reza
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Kevin Um
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Teoh
- Southlake Regional Health Sciences Centre, Newmarket, Ontario, Canada
| | - Waleed Alhazzani
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - André Lamy
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Emilie P Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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14
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Chung YH, Lee SH, Ko YG, Lee S, Shim CY, Ahn CM, Hong GR, Shim JK, Kwak YL, Hong MK. Transcatheter Aortic Valve Replacement versus Sutureless Aortic Valve Replacement: A Single Center Retrospective Cohort Study. Yonsei Med J 2021; 62:885-894. [PMID: 34558867 PMCID: PMC8470564 DOI: 10.3349/ymj.2021.62.10.885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR). MATERIALS AND METHODS In total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared. RESULTS Device success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9±1.6 days vs. 5.9±9.2 days, p=0.009) and hospital (7.1±7.9 days vs. 13.1±8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960). CONCLUSION TAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.
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Affiliation(s)
- Young Hak Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi-Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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15
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Bejko J, Della Barbera M, Valente M, Pettenazzo E, Gregori D, Basso C, Thiene G. Morphologic investigation on Perceval S, a sutureless pericardial valve prosthesis: collagen integrity after collapsing-ballooning and structural valve deterioration at distance. Int J Cardiol 2021; 341:62-67. [PMID: 34324948 DOI: 10.1016/j.ijcard.2021.07.050] [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: 06/03/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
Perceval S is a self-expandable, stent-mounted bioprosthetic valve (BPV), with glutaraldehyde treated bovine pericardium, processed with homocysteic acid as an anti-calcification treatment. The stent is crimpable but the valve insertion is done surgically via a shorter procedure which does not require sutures. OBJECTIVES: MATERIAL AND METHODS: RESULTS: CONCLUSIONS: Collapsing and ballooning do not alter cusp collagen periodicity. Structural valve deterioration with stenosis, due to dystrophic calcification and fibrous tissue overgrowth, seldom occurred in the mid-term. Glutaraldehyde fixed pericardium has the potential to undergo structural valve deterioration with time, similar to well-known BPV failure. This supports the recommendation to pursue improvement of tissue valve treatment with enhanced durability.
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Affiliation(s)
- Jonida Bejko
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Mila Della Barbera
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Marialuisa Valente
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Elena Pettenazzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy.
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16
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Al-Maisary S, Farag M, Te Gussinklo WH, Kremer J, Pleger ST, Leuschner F, Karck M, Szabo G, Arif R. Are Sutureless and Rapid-Deployment Aortic Valves a Serious Alternative to TA-TAVI? A Matched-Pairs Analysis. J Clin Med 2021; 10:jcm10143072. [PMID: 34300238 PMCID: PMC8306831 DOI: 10.3390/jcm10143072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation is a feasible alternative to conventional aortic valve replacement with expanding indication extending to low-risk patients. Sutureless and rapid-deployment aortic valves were developed to decrease procedural risks in conventional treatment. This paired-match analysis aims to compare patients undergoing surgical transcatheter aortic valve implantation to sutureless and rapid-deployment aortic valve implantation. METHODS Retrospective database analysis between 2010 and 2016 revealed 214 patients undergoing transcatheter aortic valve implantation procedures through surgical access (predominantly transapical) and 62 sutureless and rapid-deployment aortic valve procedures including 26 patients in need of concomitant coronary artery bypass surgery. After matching, 52 pairs of patients were included and analyzed. RESULTS In-hospital death (5.8% vs. 3.8%; p = 0.308) was comparable between transcatheter aortic valve implantation (mean age 77 ± 4.3 years) and sutureless and rapid-deployment aortic valve implantation groups (mean age 75 ± 4.0 years), including 32 females in each group. The logistic EuroSCORE was similar (19 ± 12 vs. 17 ± 10; p = 0.257). Postoperative renal failure (p = 0.087) and cerebrovascular accidents (p = 0.315) were without significant difference. The incidence of complete heart block requiring permanent pacemaker treatment was relatively low for both groups (1.9% vs. 7.7%; p = 0.169) for TAVI and sutureless and rapid-deployment valves respectively. Intraoperative use of blood transfusion was higher in the sutureless and rapid-deployment aortic valve implantation group (0.72 U vs. 1.46 U, p = 0.014). Estimated survival calculated no significant difference between both groups after 6 months (transcatheter aortic valve implantation: 74 ± 8% vs. sutureless and rapid-deployment aortic valve implantation: 92 ± 5%; log rank p = 0.097). CONCLUSION Since sutureless and rapid-deployment aortic valve implantation is as safe and effective as transapical transcatheter aortic valve implantation, combining the advantage of standard diseased-valve removal with shorter procedural times, sutureless and rapid-deployment aortic valve replacement may be considered as an alternative for patients with elevated operative risk considered to be in the "gray zone" between transcatheter aortic valve implantation and conventional surgery, especially if concomitant myocardial revascularization is required.
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Affiliation(s)
- Sameer Al-Maisary
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
- Correspondence: ; Tel.: +49-(0)-6221-56-6272; Fax: +49-(0)-6221-56-5585
| | - Mina Farag
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
| | - Willem Hendrik Te Gussinklo
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
| | - Jamila Kremer
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
| | - Sven T. Pleger
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.T.P.); (F.L.)
| | - Florian Leuschner
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.T.P.); (F.L.)
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
| | - Gabor Szabo
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
- Department of Cardiac Surgery, Halle University, 06120 Halle, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
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17
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Kim DJ, Lee S, Joo HC, Youn YN, Yoo KJ, Lee SH. Clinical and Hemodynamic Outcomes in 121 Patients Who Underwent Perceval Sutureless Aortic Valve Implantation - Early Results From a Single Korean Institution. Circ J 2021; 85:1011-1017. [PMID: 33994411 DOI: 10.1253/circj.cj-21-0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to evaluate the early outcomes of Perceval sutureless valves in the Korean population and to introduce a modified technique of guiding suture placement during valve deployment. METHODS AND RESULTS From December 2014 to April 2019, 121 patients (mean age: 74.7±6.2 years; 53.7% female) received a Perceval sutureless aortic valve replacement. To prevent conduction system injury, the depth of guiding suture placement (1 mm below the nadir of the annulus) was modified. All patients underwent echocardiographic evaluation at discharge and 6-12 months postoperatively, with a mean follow up of 13.7±11.2 months. Concomitant surgeries, such as coronary artery bypass grafting, and other valvular surgeries, were performed in 45.5% of cases. The mean aortic cross-clamp times for isolated and minimal procedures were 32.8±7.9, and 41.2±8.0 min, respectively. The overall transvalvular mean gradients were 13.1±3.8 mmHg at discharge and 11.5±4.7 mmHg at the last follow up. After modifying the guiding suture placement, permanent pacemaker implantation risk decreased from 9.9% to 2.5%. Cardiac-related mortality was 0.8%, with no patient developing valvular or paravalvular aortic regurgitation, valve thrombosis, or endocarditis. CONCLUSIONS Perceval valve implantation provided a significant cardiac-related survival benefit with excellent early hemodynamic and clinical outcomes. Further research is needed to determine whether adjusting the implantation depth, such as modification of the guiding suture technique, can reduce the risk of permanent pacemaker implantation.
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Affiliation(s)
- Do Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Sak Lee
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Hyun-Chel Joo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Kyung-Jong Yoo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
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18
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Lam KY, Reardon MJ, Yakubov SJ, Modine T, Fremes S, Tonino PAL, Tan ME, Gleason TG, Harrison JK, Hughes GC, Oh JK, Head SJ, Huang J, Deeb GM. Surgical sutureless and sutured aortic valve replacement in low-risk patients. Ann Thorac Surg 2021; 113:616-622. [PMID: 33794164 DOI: 10.1016/j.athoracsur.2021.03.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Randomized clinical trials have shown that transcatheter aortic valve replacement (TAVR) is noninferior to surgery in low surgical risk patients. We compared outcomes in patients treated with a sutured (stented or stentless) or sutureless surgical valve from the Evolut Low Risk Trial. METHODS The Evolut Low Risk Trial enrolled patients with severe aortic stenosis and low surgical risk. Patients were randomized to self-expanding TAVR or surgery. Use of sutureless or sutured valves was at the surgeons' discretion. RESULTS There were 680 patients who underwent surgical aortic valve implantation (205 sutureless, 475 sutured). The VARC-2 30-day safety composite endpoint was similar in the sutureless and sutured group (10.8% vs 11.0%, P=.93). All-cause mortality between groups was similar between groups at 30 days (0.5% vs 1.5%, P=.28) and 1 year (3.3% vs 2.6%, P=.74). Disabling stroke was also similar at 30 days (2.0% vs 1.5%, P=.65) and 1 year (2.6% vs 2.2%, P=.76). Permanent pacemaker implantation at 30 days was significantly higher in the sutureless compared with the sutured group (14.4% vs 2.9%, P<.001). AV-related hospitalizations occurred more often at 1 year with sutureless valves (9.1% vs 5.1%, P=.04). Mean gradients 1 year after sutureless and sutured AVR were 9.9±4.2 vs 11.7±4.7mm Hg (P<.001). CONCLUSIONS Among low-risk patients, sutureless versus sutured valve use did not demonstrate a benefit in terms of 30-day complications and produced marginally better hemodynamics, but with an increased rate of pacemaker implantation and valve-related hospitalizations.
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Affiliation(s)
- Ka Yan Lam
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Debakey Heart and Vascular Center, Houston, TX
| | - Steven J Yakubov
- Department of Cardiology, Riverside Methodist - Ohio Health, Columbus, OH
| | - Thomas Modine
- Department of Cardiac Surgery, Lille University Hospital, Lille, France
| | - Stephen Fremes
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Pim A L Tonino
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - M Erwin Tan
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | | | | | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | | - G Michael Deeb
- Departments of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, MI
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Sef D, Krajnc M, Klokocovnik T. Minimally invasive aortic valve replacement with sutureless bioprosthesis through right minithoracotomy with completely central cannulation-Early results in 203 patients. J Card Surg 2020; 36:558-564. [PMID: 33314301 DOI: 10.1111/jocs.15257] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Minimally invasive aortic valve replacement (mini-AVR) might improve clinical outcomes, particularly in high-risk and elderly patients. Sutureless/rapid deployment bioprosthesis can offer advantage of decreasing the cross-clamp time (XCT) and easing the procedure. Our aim was to evaluate the safety and perioperative outcomes of mini-AVR using sutureless bioprothesis via the right minithoracotomy approach with our modified technique of central cannulation. METHODS We performed a single-center retrospective analysis of 203 patients consecutively undergoing isolated AVR between March 2016 and June 2018 with the right minithoracotomy approach and our modified technique of central cannulation. Aortic valve diseases were stenosis (89.9%), regurgitation (1.6%), and mixed valve disease (8.5%). Patients with concomitant procedures were excluded. Primary endpoints were 30-day and 4-month mortality. RESULTS Mean age was 76 ± 6.2 years, 63 (31%) patients were 80 years or older. Cardiopulmonary bypass and XCT were 60.5 (39-153) and 35 (24-76) min, respectively. Thirty-day and 4-month mortality were 1% (two patients). We have observed minor paravalvular leak (PVL) which occurred in seven patients (3.4%), and no moderate/severe PVL was found perioperatively. One patient developed moderate/severe PVL during the 4-month follow-up. There was no structural valve degeneration. Two (1%) patients needed conversion to full sternotomy, and two (1%) patients to ministernotomy. CONCLUSIONS Mini-AVR via the right minithoracotomy approach with central cannulation is an effective and safe procedure and demonstrates excellent early clinical outcomes. This approach can be particularly valuable in higher risk and elderly patients.
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Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Surgery and Transplant Unit, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Martina Krajnc
- Department of Cardiovascular Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Tomislav Klokocovnik
- Department of Cardiovascular Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
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Abdel-Wahab M, Fujita B, Frerker C, Bauer T, Beckmann A, Bekeredjian R, Bleiziffer S, Möllmann H, Walther T, Hamm C, Beyersdorf F, Zeiher A, Gummert J, Herrmann E, Borger MA, Holzhey D, Thiele H, Ensminger S. Transcatheter Versus Rapid-Deployment Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:2642-2654. [DOI: 10.1016/j.jcin.2020.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
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Fiore A, Gueldich M, Folliguet T. Sutureless valves fit/perform well in a small aortic annulus. Ann Cardiothorac Surg 2020; 9:414-416. [PMID: 33102181 DOI: 10.21037/acs.2020.04.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Majdi Gueldich
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
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22
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Bilkhu R, Borger MA, Briffa NP, Jahangiri M. Sutureless aortic valve prostheses. Heart 2020; 105:s16-s20. [PMID: 30846520 DOI: 10.1136/heartjnl-2018-313513] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 11/03/2022] Open
Abstract
Conventional surgical aortic valve replacement (AVR) is the 'gold standard' for treatment of severe or symptomatic aortic valve stenosis. The increasing age of patients and increasing comorbidities has led to the development of procedures to minimise operative time and reduce risks of surgery. One method of reducing operative times is the use of sutureless aortic valves (SU-AVR). We examine the current literature surrounding the use of SU-AVR. Alternatives to AVR are SU-AVR, sometimes referred to as rapid deployment valves, or transcatheter aortic valve implantation (TAVI). TAVI has been demonstrated to be superior over medical therapy in patients deemed inoperable and non-inferior in high and intermediate-risk patients compared with surgical AVR. However, the lack of excision of the calcified aortic valve and annulus raises concerns regarding long-term durability and possibly thromboembolic complications. TAVI patients have increased rates of paravalvular leaks, major vascular complications and pacemaker implantation when compared with conventional AVR. SU-AVR minimises the need for suturing, leading to reduced operative times, while enabling complete removal of the calcified valve. The increase in use of SU-AVR has been mostly driven by minimally invasive surgery. Other indications include patients with a small and/or calcified aortic root, as well as patients requiring AVR and concomitant surgery. SU-AVR is associated with decreased operative times and possibly improved haemodynamics when compared with conventional AVR. However, this has to be weighed against the increased risk of paravalvular leak and pacemaker implantation when deciding which prosthesis to use for AVR.
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Affiliation(s)
- Rajdeep Bilkhu
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Norman Paul Briffa
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
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23
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Papakonstantinou NA, Baikoussis NG. The Perceval S valve. Making the good better… or optimal? Eur J Cardiothorac Surg 2020; 57:812-813. [PMID: 31750893 DOI: 10.1093/ejcts/ezz315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/24/2019] [Indexed: 11/13/2022] Open
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Abstract
Aortic valve replacement has stood the test of time but is no longer an operation that is exclusively approached through a median sternotomy using only sutured prostheses. Currently, surgical aortic valve replacement can be performed through a number of minimally invasive approaches employing conventional mechanical or bioprostheses as well as sutureless valves. In either case, the direct surgical access allows inspection of the valve, complete excision of the diseased leaflets, and debridement of the annulus in a controlled and thorough manner under visual control. It can be employed to treat aortic valve pathologies of all natures and aetiologies. When compared with transcatheter valves in patients with a high or intermediate preoperative predictive risk, conventional surgery has not been shown to be inferior to transcatheter valve implants. As our understanding of sutureless valves and their applicability to minimally invasive surgery advances, the invasiveness and trauma of surgery can be reduced and outcomes can improve. This warrants further comparative trials comparing sutureless and transcatheter valves.
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Affiliation(s)
- Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
| | - Khalid Alkhamees
- Department of Cardiac Surgery, Prince Sultan Cardiac Center Al Hassa, Prince Fawaz bin Abdulaziz St., Hofuf city, 31982, Saudi Arabia
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
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Ielasi A, Latib A, Tespili M, Donatelli F. Current results and remaining challenges of trans-catheter aortic valve replacement expansion in intermediate and low risk patients. IJC HEART & VASCULATURE 2019; 23:100375. [PMID: 31193348 PMCID: PMC6525308 DOI: 10.1016/j.ijcha.2019.100375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/01/2019] [Accepted: 05/04/2019] [Indexed: 01/15/2023]
Abstract
TAVR has become the standard treatment in patients at increased surgical risk (STS or EuroSCORE II ≥4% or logistic EuroSCORE I ≥ 10% or other risk factors not included in these scores such as frailty, porcelain aorta, sequelae of chest radiation) and it is increasingly being performed in patients at intermediate to low (STS or EuroSCORE II <4% or logistic EuroSCORE I < 10%) surgical risk. Although non-inferiority has been demonstrated in intermediate and low-risk patients, several challenges need to be addressed before expansion to younger patients. Current trends, trials results, and remaining challenges are summarized and discussed in this review.
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Affiliation(s)
- Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Azeem Latib
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Francesco Donatelli
- Cardiac Surgery Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
- Chair of Cardiac Surgery, University of Milan, Milan, Italy
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Kosmas I, Iakovou I, Leontiadis E, Sbarouni E, Georgiadou P, Bousoula E, Aravanis N, Stratinaki M, Voudris V, Mpalanika M. The first transcatheter valve-in-valve implantation of a self-expandable valve for the treatment of a degenerated sutureless aortic bioprosthesis. Hellenic J Cardiol 2019; 61:49-50. [PMID: 31039413 DOI: 10.1016/j.hjc.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- I Kosmas
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece.
| | - I Iakovou
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - E Leontiadis
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - E Sbarouni
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - P Georgiadou
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - E Bousoula
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - N Aravanis
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - M Stratinaki
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - V Voudris
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - M Mpalanika
- Department of Anaesthesiology, Onassis Cardiac Surgery Center, Greece
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Estevez-Cid F, Serrano-Teruel ME, Fernandez-Rodriguez F, Bouzas-Mosquera A, Fernandez-Moreno M, Dieguez-Garcia P, Cuenca-Castillo JJ, Bautista-Hernandez V. Postoperative Plasma Mitochondrial DNA and Cytokine Profiles of Elderly Patients Undergoing Minimally Invasive Aortic Valve Replacement. Thorac Cardiovasc Surg 2019; 69:34-42. [PMID: 30873579 DOI: 10.1055/s-0039-1683427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Mitochondrial DNA (mtDNA) is gaining increasing interest as a marker of cellular damage and could also act as an inflammatory mediator in cardiopulmonary bypass induced postoperative inflammatory response. Although minimally invasive heart valve surgery reportedly reduces inflammation, the mtDNA and cytokine profile in this context remains unclear. MATERIALS AND METHODS Here, we report a prospective series of 40 elderly patients with aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR) through upper ministernotomy with either a sutureless (n = 20) or a conventional (n = 20) valve. Primary end points included serial plasma levels of mtDNA (T1: at baseline; T2: 4 hours after surgery; and T3: 24s hour after surgery), cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), and myocardial necrosis biomarkers (MNBs), whereas secondary end points included clinical and echocardiographic data. RESULTS Significant increases in the postoperative plasma levels (T2) of mtDNA, cytokines, and MNBs were observed in all patients. The postoperative plasma levels of mtDNA, TNF-α, and MNBs showed no significant differences between the treatment groups, although there was a trend toward lower levels in the sutureless group. The decreases in aortic cross-clamp and cardiopulmonary bypass times seen in the sutureless group were associated with significant lower postoperative levels (T2 and T3) of IL-6. CONCLUSION AVR through upper ministernotomy was associated with a significant increase in postoperative plasma levels of mtDNA and cytokines. There was no difference in the mtDNA levels between the sutureless and conventional valve groups, suggesting a similar level of inflammation in both groups. However, the shorter operation time observed in the sutureless valve group was associated with significantly lower postoperative levels of IL-6, indicating potential clinical benefits.
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Affiliation(s)
- Francisco Estevez-Cid
- Department of Cardiac Surgery, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain.,Department of Experimental Cardiovascular Surgery, Institute of Biomedical Research of A Coruna, A Coruna, Spain
| | - Maria E Serrano-Teruel
- Department of Experimental Cardiovascular Surgery, Institute of Biomedical Research of A Coruna, A Coruna, Spain
| | | | | | - Mercedes Fernandez-Moreno
- Department of Experimental Cardiovascular Surgery, Institute of Biomedical Research of A Coruna, A Coruna, Spain
| | - Paula Dieguez-Garcia
- Department of Anesthesiology Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
| | - Jose J Cuenca-Castillo
- Department of Cardiac Surgery, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
| | - Victor Bautista-Hernandez
- Department of Cardiac Surgery, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain.,Department of Experimental Cardiovascular Surgery, Institute of Biomedical Research of A Coruna, A Coruna, Spain
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Povero M, Miceli A, Pradelli L, Ferrarini M, Pinciroli M, Glauber M. Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:733-745. [PMID: 30510436 PMCID: PMC6231515 DOI: 10.2147/ceor.s185743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Meta-analyses of studies comparing transcatheter aortic valve implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show differing effectiveness and safety profiles. The approaches also differ in their surgical cost (including operating room and device). OBJECTIVE The objective of this study was to assess the incremental cost-utility of SU-AVR vs TAVIs for the treatment of intermediate- to high-risk patients in the US, Germany, France, Italy, UK, and Australia. METHODS A patient-level simulation compares in-hospital pathways of patients undergoing SU-AVR or TAVIs; later, patient history is modeled at the cohort level. Hospital outcomes for TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates in a recent meta-analysis on 1,462 patients. After discharge, survival depends on the development of paravalvular leak and the need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted. RESULTS Due to lower in-hospital (4.1% vs 7.0%) and overall mortality, patients treated with SU-AVR are expected to live an average of 1.25 years more compared with those undergoing TAVIs, with a mean gain of 1.14 quality-adjusted life-years. Both in-hospital and long-term costs were lower for SU-AVR than for TAVIs with total savings ranging from $4,158 (France) to $20,930 (US). CONCLUSION SU-AVR results dominant when compared to TAVIs in intermediate- to high-risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for the quality of life.
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Affiliation(s)
| | - Antonio Miceli
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Matteo Ferrarini
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | | | - Mattia Glauber
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
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Literaturübersicht 2017 zur Herzklappenchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-018-0248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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