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Hong S, Son JW, Yoon Y. Clinical Midterm Results of Surgical Aortic Valve Replacement with Sutureless Valves. J Chest Surg 2024; 57:255-262. [PMID: 38528758 PMCID: PMC11089058 DOI: 10.5090/jcs.23.142] [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: 10/10/2023] [Revised: 12/20/2023] [Accepted: 01/18/2024] [Indexed: 03/27/2024] Open
Abstract
Background Sutureless aortic valves may enable shorter procedure times, which benefits patients with elevated surgical risk. We describe the outcomes of patients with aortic stenosis who underwent aortic valve replacement (AVR) using the sutureless Perceval aortic bioprosthesis. Methods Data from a retrospective cohort were obtained from a clinical database. The study enrolled patients with symptomatic severe aortic stenosis who underwent surgical AVR with a sutureless bioprosthesis between August 2015 and December 2020. In total, 113 patients were included (mean age, 75.3±8.4 years; 57.5% women; median Society of Thoracic Surgeons score, 9.7%; mean follow-up period, 51.19±20.6 months). Of these patients, 41 were octogenarians (36.2%) and 3 were nonagenarians (2.6%). Transthoracic echocardiography was employed to assess changes in ejection fraction (EF), left ventricular mass index (LVMI), and mean pressure gradient (MPG). Results The in-hospital mortality rate was 2.6%, and 13 patients developed new-onset atrial fibrillation. A permanent pacemaker was implanted in 3 patients (2.6%). The median intensive care unit stay was 1 day (interquartile range [IQR], 1-2 days), and the median hospital stay was 12 days (IQR, 9.5-15 days). The overall survival rate at 5 years was 95.9%. LVMI and MPG were reduced postoperatively, while EF increased over the follow-up period. No structural valve deterioration was observed, and no meaningful paravalvular leakage developed during follow-up. Conclusion The use of a sutureless valve in the aortic position is safe and feasible, even for high-risk elderly patients requiring surgical AVR. LVMI and MPG decreased postoperatively, while EF increased over the follow-up period.
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Affiliation(s)
- Soonchang Hong
- Department of Cardiothoracic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jung-Woo Son
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yungjin Yoon
- Department of Cardiothoracic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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Schizas N, Samiotis I, Nazou G, Iliopoulos DC, Anagnostopoulos I, Kousta M, Papaioannou N, Argiriou M, Dedeilias P. Perceval-S over time. Clinical outcomes after ten years of usage. J Cardiothorac Surg 2024; 19:192. [PMID: 38594705 PMCID: PMC11003077 DOI: 10.1186/s13019-024-02617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Perceval-S has become a reliable and commonly used option in surgical aortic valve replacement (AVR) since its first implantation in humans 15 years ago. Despite the fact that this aortic valve has been proven efficient enough in the short and mid-term period, there is still lack of evidence for the long-term outcomes. MATERIALS AND METHODS This is an observational retrospective study in a high-volume cardiovascular center. Pertinent data were collected for all the patients in whom Perceval-S was implanted from 2013 to 2020. RESULTS The total number of patients was 205 with a mean age 76.4 years. Mean survival time was 5.5 years (SE = 0.26). The overall survival probability of patients undergoing aortic valve replacement with Perceval-S at 6 months was 91.0% (Standard Error SE = 2.0%), at one year 88.4% (SE = 2.3%) and at 5-years 64.8% (SE = 4.4%). A detrimental cardiac event leading to death was the probable cause of death in 35 patients (55.6%). The initiation of Transcatheter Aortic Valve Replacement (TAVR) program in our center in 2017 was associated with a decline in the number of very high-risk patients treated with sutureless bioprosthesis. This fact is demonstrated by the significant shift towards lower surgical risk cases, as median Euroscore II was reduced from 5,550 in 2016 to 3,390 in 2020. Mini sternotomy was implemented in 79,5% of cases favoring less invasive approach. Low incidence of reinterventions, patient prosthesis mismatch and structural valve degeneration was detected. CONCLUSIONS The survival rate after aortic valve replacement with implantation of Perceval-S is satisfactory in the long-term follow-up. Cases of bioprosthesis dysfunction were limited. Mini sternotomy was used in the majority of cases. TAVR initiation program impacted on the proportion of patients treated with Perceval-S with reduction of high-risk patients submitted to surgery.
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Affiliation(s)
- Nikolaos Schizas
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Athens, Greece.
| | - Ilias Samiotis
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Athens, Greece
| | - Georgia Nazou
- Department of Anesthesiology, Evangelismos General Hospital, Athens, Greece
| | | | | | - Maria Kousta
- Department of Cardiology, G. Gennimatas General Hospital, Athens, Greece
| | - Nafsika Papaioannou
- Environmental Engineering Laboratory, Aristotle University, Thessaloniki, Greece
| | - Mihalis Argiriou
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Athens, Greece
| | - Panagiotis Dedeilias
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Athens, Greece
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Elzomor H, Elkoumy A, Hothi SS, Soliman O. Considering alternatives to transcatheter heart valves for managing patients with severe aortic valve stenosis. Expert Rev Med Devices 2024; 21:109-120. [PMID: 38166517 DOI: 10.1080/17434440.2023.2298716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/20/2023] [Indexed: 01/04/2024]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is becoming the standard of care for severe symptomatic aortic stenosis (AS). Yet, some patients with AS are not indicated/eligible for TAVI. Several noninvasive, catheter-based or surgical alternatives exist, and other therapeutic options are emerging. AREAS COVERED This review provides an overview of non-TAVI options for severe AS. Non-invasive, transcatheter, and alternative surgical strategies are discussed, emphasizing their backgrounds, techniques, and outcomes. EXPERT OPINION Alternative therapies to TAVI, whether device-based or non-device-based, continue to evolve or emerge and provide either alternative treatments or a bridge to TAVI, for patients not meeting indications for, or having contraindications to TAVI.Although TAVI and SAVR are the current dominant therapies, there are still some patients that could benefit in the future from other alternatives.Data on alternative options for such patients are scarce. Many advantages and disadvantages arise when selecting a specific treatment strategy for individual patients.Head-to-head comparison studies could guide physicians toward better patient selection and procedural planning. Awareness of therapeutic options, indications, techniques, and outcomes should enable heart teams to achieve optimized patient selection. Furthermore, it can increase the use of these alternatives to optimize the management of AS among different patient populations.
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Affiliation(s)
- Hesham Elzomor
- Department of Cardiology, Saolta Group, Galway University Hospital, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- Islamic Center of Cardiology, Al-Azhar University, Nasr City, Cairo, Egypt
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Ahmed Elkoumy
- Department of Cardiology, Saolta Group, Galway University Hospital, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- Islamic Center of Cardiology, Al-Azhar University, Nasr City, Cairo, Egypt
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
| | - Sandeep S Hothi
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Osama Soliman
- Department of Cardiology, Saolta Group, Galway University Hospital, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- Islamic Center of Cardiology, Al-Azhar University, Nasr City, Cairo, Egypt
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Euro Heart Foundation, Rotterdam, The Netherlands
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4
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Haeussler A, Ntinopoulos V, Rings L, Papadopoulos N, Hoti G, Fleckenstein P, Dzemali O. Thrombocytopenia after Implantation of the Perceval, Intuity, and Sapien Aortic Valve Prostheses. Thorac Cardiovasc Surg 2023; 71:550-556. [PMID: 36462753 DOI: 10.1055/s-0042-1757893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND An increased incidence of thrombocytopenia was reported after implantation of the LivaNova Perceval and the Edwards Sapien aortic valve bioprostheses. Aim of this study is to assess the perioperative platelet count and bleeding complications in three different types of aortic valve bioprostheses intended for high-risk patients, the sutureless LivaNova Perceval, the rapid deployment Edwards Intuity, and the transcatheter Edwards Sapien. METHODS We performed a retrospective analysis of the perioperative data of patients receiving the Perceval, Intuity, and Sapien aortic valve bioprosthesis. The platelet count was collected preoperatively, at nadir postoperatively, and at discharge. The bioprostheses were compared for between-group differences in platelet count and postoperative bleeding complications. RESULTS Overall, 37 patients received the Perceval, 42 the Intuity, and 58 the Sapien bioprosthesis. There was no significant between-group difference in the preoperative platelet count [Perceval 203(178-246)G/l, Intuity 214(190-232)G/l, Sapien 201(178-275)G/l, p = 0.800]. There was a significant between-group difference in the postoperative platelet count, both at nadir value [Perceval 57(37-80)G/l, Intuity 91(73-109)G/l, Sapien 126(105-170)G/l, p < 0.0001] and at discharge [Perceval 150(83-257)G/l, Intuity 239(200-343)G/l, Sapien 232(179-284)G/l, p = 0.001]. There was no significant between-group difference regarding red blood cell transfusions (p = 0.242), platelet transfusions (p = 0.656), and rethoracotomy for bleeding (p = 0.847). CONCLUSION We found a significant platelet count reduction in all three bioprostheses which was more marked in the Perceval group. The platelet count reduction was transient and fully recovered in the Intuity and Sapien groups, whereas the Perceval group showed only a partial platelet count recovery. However, bleeding complications were not different between the three bioprostheses.
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Affiliation(s)
- Achim Haeussler
- Department of Cardiac Surgery, City Hospital of Zurich - Triemli, Zurich, Switzerland
| | - Vasileios Ntinopoulos
- Department of Cardiac Surgery, City Hospital of Zurich - Triemli, Zurich, Switzerland
| | - Laura Rings
- Department of Cardiac Surgery, City Hospital of Zurich - Triemli, Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, City Hospital of Zurich - Triemli, Zurich, Switzerland
| | - Gojart Hoti
- Department of Cardiac Surgery, City Hospital of Zurich - Triemli, Zurich, Switzerland
| | - Philine Fleckenstein
- Department of Cardiac Surgery, City Hospital of Zurich - Triemli, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, City Hospital of Zurich - Triemli, Zurich, Switzerland
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5
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Zaheer S, Quinn RD, Robich MP. The 7 Pillars for Perceval Implantation With Mitral Valve Repair or Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:308-310. [PMID: 37599511 DOI: 10.1177/15569845231190877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Affiliation(s)
- Salman Zaheer
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reed D Quinn
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael P Robich
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Dokollari A, Torregrossa G, Bisleri G, Hassanabad AF, Sa MP, Sicouri S, Veshti A, Prifti E, Bacchi B, Cabrucci F, Ramlawi B, Bonacchi M. Early and Long-Term Clinical and Echocardiographic Outcomes of Sutureless vs. Sutured Bioprosthesis for Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:jcdd10050224. [PMID: 37233191 DOI: 10.3390/jcdd10050224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
Objective: The goal of this manuscript is to compare clinical and echocardiographic outcomes of patients undergoing aortic valve replacement (AVR) with Perceval sutureless bioprosthesis (SU-AVR) and sutured bioprosthesis (SB). Methods: Following the PRISMA statement, data were extracted from studies published after August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post-procedural permanent pacemaker implantation, and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop-out), need for a second transcatheter heart valve, 30-day mortality, stroke, and echocardiographic outcomes. Results: Twenty-one studies were included in the analysis. When SU-AVR was compared to other SB, mortality ranged from 0 to 6.4% for Perceval and 0 to 5.9% for SB. Incidence of PVL (Perceval 1-19.4% vs. SB 0-1%), PPI (Perceval 2-10.7% vs. SB 1.8-8.5%), and MI (Perceval 0-7.8% vs. SB 0-4.3%) were comparable. In addition, the stroke rate was lower in the SU-AVR group when compared to SB (Perceval 0-3.7% vs. SB 1.8-7.3%). In patients with a bicuspid aortic valve, the mortality rate was 0-4% and PVL incidence was 0-2.3%. Long-term survival ranged between 96.7 and 98.6%. Valve cost analysis was lower for the Perceval valve and higher for sutured bioprosthesis. Conclusions: Compared to SB valves, Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its non-inferior hemodynamics, implantation speed, reduced cardiopulmonary bypass time, reduced aortic cross-clamp time, and shorter length of stay.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | | | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| | - Michel Pompeu Sa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Altin Veshti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Edvin Prifti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Beatrice Bacchi
- St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Francesco Cabrucci
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Massimo Bonacchi
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
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7
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Sonaglioni A, Grasso E, Nicolosi GL, Trevisan R, Martinelli GL, Lombardo M. An Unusual Case of Ascending Aorta Dissection 4 Years after Perceval Sutureless Bioprosthesis Implantation: Easier Access to Diagnosis through the Right Parasternal Longitudinal Echocardiographic Window. J Cardiovasc Echogr 2023; 33:98-101. [PMID: 37772053 PMCID: PMC10529284 DOI: 10.4103/jcecho.jcecho_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 09/30/2023] Open
Abstract
Sutureless bioprostheses are more frequently used for the surgical treatment of elderly patients with high burden of comorbidity, who are candidates to aortic valve replacement (AVR). Among the sutureless bioprostheses, the Perceval valve has shown a good midterm durability, with very few reports of valve deterioration and low risk of complications. Herein, we present an unusual case of ascending aorta dissection which occurred 4 years after AVR with a Perceval sutureless pericardial bioprosthesis, likely related to the peculiar prosthetic design. A high right parasternal longitudinal view of the aorta in the right lateral decubitus allowed to suspect the acute aortic syndrome, thus accelerating the subsequent diagnostic and therapeutic iter.
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Affiliation(s)
- Andrea Sonaglioni
- Division of Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Enzo Grasso
- Division of Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | | | - Roberta Trevisan
- Division of Radiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Gian Luca Martinelli
- Division of Cardiac Surgery, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Michele Lombardo
- Division of Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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Kolar T, Lakič N, Kotnik A, Štubljar D, Fras Z, Bunc M. Similar clinical outcomes with transcatheter aortic valve implantation and surgical aortic valve replacement in octogenarians with aortic stenosis. Front Cardiovasc Med 2022; 9:947197. [DOI: 10.3389/fcvm.2022.947197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTranscatheter aortic valve implantation (TAVI) is the preferred treatment option for severe aortic stenosis in the elderly and in patients with comorbidities. We sought to compare outcomes after TAVI and surgical aortic valve replacement (SAVR) in octogenarians.MethodsIn this retrospective cohort study conducted at our tertiary center, clinical data were gathered before and after TAVI and SAVR procedures performed from January 2013 to May 2019; follow-up completed in March 2021. The primary outcome was 1-year mortality. Patients were stratified according to Society of Thoracic Surgeons (STS) score and procedure type. Propensity score-based matching was also performed.ResultsOf 542 patients who matched the inclusion criteria, 273 underwent TAVI and 269 SAVR. TAVI patients were older (85.8 ± 3.0 vs. 82.2 ± 2.2 years; P < 0.001) and had a higher mean STS score (5.0 ± 4.0 vs. 2.8 ± 1.3; P < 0.001) and EuroSCORE II (5.3 ± 4.1 vs. 2.8 ± 6.0; P < 0.001). Rates of postoperative permanent pacemaker insertion (15.0% vs. 9.3%; P = 0.040) and paravalvular leak (9.9% vs. 0.8%; P < 0.001) were higher and acute kidney injury lower (8.8% vs. 32.7%; P < 0.001) after TAVI, with no difference between treatment groups for major bleeding (11.0% vs. 6.7%; P = 0.130) or 30-day mortality (5.5% vs. 3.7%; P = 0.315). A statistically significant difference was found between TAVI and SAVR in low- and intermediate-risk groups when it came to occurrence of paravalvular leak, acute kidney injury, and new onset AF (all P < 0.001).ConclusionThis analysis of an octogenarian “real-life” population undergoing TAVI or SAVR (with a biological valve) showed similar outcomes regarding clinical endpoints in low- and medium-risk (STS score) groups.
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9
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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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10
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Aortic annulus rupture with fistula to the right ventricle following aortic valve replacement with a sutureless valve: A surgical complication with a percutaneous solution. Rev Port Cardiol 2022; 41:719.e1-719.e5. [DOI: 10.1016/j.repc.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 06/08/2019] [Indexed: 11/24/2022] Open
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11
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Nakamura Y, Narita T, Kuroda M, Nakayama T, Tsuruta R, Yoshiyama D, Yasumoto Y, Sawa S, Furutachi A, Ito Y. Sutureless Aortic Valve Replacement Through Lateral Mini-Thoracotomy - Feasibility and Effectiveness. Circ J 2022; 86:1733-1739. [PMID: 35896351 DOI: 10.1253/circj.cj-22-0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Minimally invasive sutureless aortic valve replacement with the Perceval bioprosthetic heart valve (MISUAVR) is commonly performed through a right anterior thoracotomy (AT). However, a lateral thoracotomy (LT) may be superior as it does not require rib and right internal thoracic artery (RITA) cutting.Methods and Results: In total, 38 MISUAVRs performed from May 2019 to approximately August 2021 were retrospectively reviewed; 21 through LT (Group L), and 17 through AT (Group A). In Group L, the skin incision was made on the right anterior axillary line and third intercostal space, and in group A, on the right anterior chest and second or third intercostal space. All other surgical techniques were the same. Age, body surface area, EuroSCORE II, and ejection fraction were similar between the patients. Cardiopulmonary bypass (L: 82±19 vs. A: 93±28 min, P=0.19) and cross-clamp times (L: 57±13, vs. A: 64±23 min, P=0.19) were similar. Rib and/or RITA cutting were required in 94.6% of patients in group A and in none of group L (P<0.001). Surgical visualization score was better in group L (L: 1.19±0.40 vs. A: 1.94±0.69, P<0.01). Total amount of intraoperative bleeding was lower in group L (L: 623±141 vs. A: 838±316 mL, P<0.01). Duration of hospital stay was similar (P=0.30). CONCLUSIONS MISUAVR through LT has multiple advantages over AT.
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Affiliation(s)
| | - Takuya Narita
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Shintaro Sawa
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Akira Furutachi
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chibanishi General Hospital
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12
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Ríos-Ortega JC, Sisniegas-Razón J, Conde-Moncada R, Pérez-Valverde Y, Morón-Castro J. Aortic valve replacement through minithoracotomy. Results from the Peruvian experience. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:69-73. [PMID: 37283599 PMCID: PMC10241336 DOI: 10.47487/apcyccv.v3i2.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 06/08/2023]
Abstract
Objectives To assess mortality, major valve-related events (MAVRE), and other complications in the perioperative period and follow up in patients with aortic valve replacement (AVR) through mini-thoracotomy (MT). Methods We retrospectively analyzed patients aged <80 who underwent AVR through MT between January 2017 and December 2021 in a national reference center in Lima, Peru. Patients undergoing other surgical approaches (mini-sternotomy, etc.), other concomitant cardiac procedures, redo, and emergency surgeries were excluded. We measured the variables (MAVRE, mortality, and other clinical variables) at 30 days and a mean follow-up of 12 months. Results Fifty-four patients were studied, the median age was 69.5 years, and 65% were women. Aortic valve (AV) stenosis was the main indication for surgery (65%), and bicuspid AV represented 55.6% of cases. At 30-days, MAVRE occurred in two patients (3.7%), with no in-hospital mortality. One patient had an intraoperative ischemic stroke, and one required a permanent pacemaker. No patient underwent reoperation due to prosthesis dysfunction or endocarditis. In a mean follow-up of one year, MAVRE occurrence did not show variations with the perioperative period, most patients remained in NYHA I (90.7%) or II (7.4%) compared to the preoperative period (p<0.001). Conclusions AV replacement through MT is a safe procedure in our center for patients under 80 years.
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Affiliation(s)
- Josías C Ríos-Ortega
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
| | - Josué Sisniegas-Razón
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
| | - Roger Conde-Moncada
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
| | - Yemmy Pérez-Valverde
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
| | - Julio Morón-Castro
- Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú
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13
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Panagiotopoulos I, Kotsopoulos N, Verras GI, Mulita F, Katinioti A, Koletsis E, Triantafyllou K, Yfantopoulos J. Perceval S, sutureless aortic valve: cost-consequence analysis. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2022; 19:22-27. [PMID: 35414814 PMCID: PMC8981134 DOI: 10.5114/kitp.2022.114551] [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: 08/12/2021] [Accepted: 12/28/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sutureless aortic valve prostheses have the potential of shortening ischemic time. AIM We conducted the present study to assess the clinical and economic impact of the biological, sutureless, self-expanding Perceval S valve since the effect of shortened operative times on hospital costs remains unclear. MATERIAL AND METHODS This is a retrospective analysis. From January 2018 to January 2019, 29 patients underwent isolated aortic valve replacement with the Crown PRT bioprosthetic Aortic Valve, whereas 35 patients underwent aortic valve replacement with Perceval S (auto-expanded, sutureless, bioprosthesis). Preoperative data, hospital outcome, and health care resource consumption were compared, using χ2 and t-test. RESULTS Aortic cross-clamp, cardiopulmonary bypass, and operation times were significantly shorter in the Perceval S group (p < 0.001). Patients in the sutureless group required blood transfusion less frequently (p = 0.03) and had a shorter intensive care unit (ICU) stay (p = 0.01). Hospital stay (p = 0.57) and pacemaker implantation were similar between groups. The reduction of aortic cross-clamp, extracorporeal circulation times, and ICU stay resulted in reduced resource consumption in the sutureless group. CONCLUSIONS The use of the Perceval S valve is clinically safe and effective. A shorter procedural time in the sutureless group is associated with better clinical outcomes and reduced hospital costs.
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Affiliation(s)
- Ioannis Panagiotopoulos
- Department of Cardiothoracic Surgery, General University, Hospital of Patras, Patras, Greece
| | - Nikolaos Kotsopoulos
- Division of Health Economics, Global Market Access Solutions, St-Prex, Switzerland
| | | | - Francesk Mulita
- Department of Surgery, General University, Hospital of Patras, Patras, Greece
| | - Anastasia Katinioti
- Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, General University, Hospital of Patras, Patras, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens, Greece
| | - John Yfantopoulos
- MBA – Health Department of Economics, National and Kapodistrian University of Athens, Athens, Greece
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14
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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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15
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White A, Nguyen Q, Hong Y, Moon M, Wang S, Wang W. Rapid Deployment Valves Are Advantageous in the Redo Setting: A Single-Centre Retrospective Study. CJC Open 2021; 4:299-304. [PMID: 35386134 PMCID: PMC8978054 DOI: 10.1016/j.cjco.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background The spectrum on how to manage aortic valve disease continues to widen. The purpose of this study is to add further clarification to the role of rapid deployment valves (RDVs) by comparing their outcomes with traditional sutured valves (TSVs) in the reoperative aortic valve replacement (AVR) setting. Methods This study was a retrospective review of all patients undergoing a second surgical reoperation for aortic valve disease. Patients were categorized into 2 groups: RDV and TSV. Cox proportional hazards regression models were used to determine the association between exposures of interest and the primary and secondary outcomes, after adjusting for all the baseline characteristics. The primary outcome was major adverse cardiovascular events (MACE) within 3 years, which was the composite of all-cause death, readmission for myocardial infarct, readmission for stroke, and readmission for heart failure. Results A total of 307 patients made up the study population from 2010 to 2019. Of those, 254 patients received TSV, and 53 patients received RDV. RDV patients were significantly older than TSV patients by 10 years, on average. Shorter cardiopulmonary bypass (CPB) times were found with the RDV group. There was no significant difference in the primary outcome of MACE within 3 years. Conclusions This single-centre large cohort study of patients with reoperative AVR found that RDVs facilitate smoother operations by saving 1 hour of cross-clamp time and CPB time. Furthermore, RDVs have comparable outcomes with TSVs, despite the significantly older patient population.
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16
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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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17
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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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18
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Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations. J Cardiovasc Dev Dis 2021; 8:jcdd8070074. [PMID: 34201997 PMCID: PMC8305208 DOI: 10.3390/jcdd8070074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/06/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Sutureless and rapid-deployment bioprostheses have been introduced as alternatives to traditional prosthetic valves to reduce cardiopulmonary and aortic cross-clamp times during aortic valve replacement. These devices have also been employed in extremely demanding surgical settings, as underlined in the present review. Searches on the PubMed and Medline databases aimed to identify, from the English-language literature, the reported cases where both sutureless and rapid-deployment prostheses were employed in challenging surgical situations, usually complex reoperations sometimes even performed as bailout procedures. We have identified 25 patients for whom a sutureless or rapid-deployment prosthesis was used in complex redo procedures: 17 patients with a failing stentless bioprosthesis, 6 patients with a failing homograft, and 2 patients with the failure of a valve-sparing procedure. All patients survived reoperation and were reported to be alive 3 months to 4 years postoperatively. Sutureless and rapid-deployment bioprostheses have proved effective in replacing degenerated stentless bioprostheses and homografts in challenging redo procedures. In these settings, they should be considered as a valid alternative not only to traditional prostheses but also in selected cases to transcatheter valve-in-valve solutions.
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19
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Papakonstantinou NA, Baikoussis NG, Dedeilias P. Perceval S valve empire: healing the Achilles' heel of sutureless aortic valves. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:625-631. [PMID: 34014059 DOI: 10.23736/s0021-9509.21.11608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic valve replacement is the treatment of choice concerning aortic valve disease. Excellent short- and longterm clinical results are reported. Patients referred for aortic valve replacement are getting older and older, so bioprosthetic valves play a more central role worldwide. However, patient comorbidities are also increased more often rendering patients unsuitable for open conventional aortic valve replacement. As a result, transcatheter aortic valve implantation has become the treatment of choice in patients at very high surgical risk. However, the percutaneous technique is related to major disadvantages provided that the diseased native valve is left in place. Its durability is also uncertain. More recently, sutureless Perceval S valve bioprosthesis has gained ground in the field of aortic stenosis therapy filling the gap between conventional aortic valve replacement and transcatheter approach. Excellent haemodynamic and clinical results are reported. Its deployment is performed under direct view and ischemic and overall operative times are significantly decreased. Five-year follow-up results are also optimal. However, the "Achilles' heel" of sutureless technology is increased rates of postoperative permanent pacemaker implantation requirement compared to conventional approach. The incidence of this complication varies in literature. Patient-related factors such as preoperative conduction disorders, older age and short membranous septum are predictors of postoperative pacemaker requirement. However, several technical modifications with regard to manufacturer recommendations can be adopted to mitigate this complication. Appropriate annular decalcification, higher guiding sutures placement, reduced balloon pressure and duration and avoiding of oversizing can contribute to prevent from this complication.
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Affiliation(s)
| | | | - Panagiotis Dedeilias
- Cardiothoracic Surgery Department, General Hospital of Athens Evangelismos', Athens, Greece
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20
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Glauber M, Kent WDT, Asimakopoulos G, Troise G, Padrò JM, Royse A, Marnette JM, Noirhomme P, Baghai M, Lewis M, Di Bacco L, Solinas M, Miceli A. Sutureless Valve in Repeated Aortic Valve Replacement: Results from an International Prospective Registry. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:273-279. [PMID: 33866845 DOI: 10.1177/1556984521999323] [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: 11/16/2022]
Abstract
OBJECTIVE To report early and midterm results registry of patients undergoing repeated aortic valve replacement (RAVR) with sutureless prostheses from an international prospective registry (SURE-AVR). METHODS Between March 2011 and June 2019, 69 patients underwent RAVR with self-expandable sutureless aortic bioprostheses at 22 international cardiac centers. RESULTS Overall mortality was 2.9% with a predicted logistic EuroSCORE II of 10.7%. Indications for RAVR were structural valve dysfunction (84.1%) and infective prosthetic endocarditis (15.9%) and were performed in patients with previously implanted bioprostheses (79.7%), mechanical valves (15.9%), and transcatheter valves (4.3%). Minimally invasive approach was performed in 15.9% of patients. Rate of stroke was 1.4% and rate of early valve-related reintervention was 1.4%. Overall survival rate at 1 and 5 years was 97% and 91%, respectively. No major paravalvular leak occurred. Rate of pacemaker implantation was 5.8% and 0.9% per patient-year early and at follow-up, respectively. The mean transvalvular gradient at 1-year and 5-year follow-up was 10.5 mm Hg and 11.5 mm Hg with a median effective orifice area of 1.8 cm2and 1.8 cm2, respectively. CONCLUSIONS RAVR with sutureless valves is a safe and effective approach and provides excellent clinical and hemodynamic results up to 5 years.
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Affiliation(s)
| | - William D T Kent
- 70401 Libin Cardiovascular Institute and University, Calgary, AB, Canada
| | | | | | | | | | | | | | - Max Baghai
- 111990 King's College Hospital, London, UK
| | - Michael Lewis
- 1949 Brighton and Sussex University Hospitals, Sussex, UK
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21
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Nishijima S, Nakamura Y, Gersak B, Namiki S, Kouzaki T, Tsuchiya Y. Successful Aortic Valve Replacement With Perceval Bioprosthesis for Aortic Stenosis With Membranous Ventricular Septum Aneurysm. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:195-197. [PMID: 33480294 DOI: 10.1177/1556984520984256] [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: 11/15/2022]
Abstract
Membranous ventricular septum aneurysm (MVSA) is extremely rare, especially when coexisting with aortic stenosis (AS), and reports regarding the available treatment for MVSA with AS are limited. Aortic valve replacement (AVR) can be challenging because of anatomical reasons. In this case report, a patient with MVSA and severe AS was treated with AVR with the sutureless Perceval bioprosthesis. After implantation, no paravalvular leakage was detected in echocardiography, and no other postoperative complications were observed. Postoperative electrocardiography-gated computed tomography revealed no contrast enhancement for MVSA. The MVSA was closed by the Perceval bioprosthetic valve. Thus, patients with simultaneous MVSA and AS may be effectively treated with AVR using a Perceval bioprosthesis.
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Affiliation(s)
- Shuhei Nishijima
- 13605 Department of Cardiovascular Surgery, Chiba-nishi General Hospital, Matsudo, Japan
| | - Yoshitsugu Nakamura
- 13605 Department of Cardiovascular Surgery, Chiba-nishi General Hospital, Matsudo, Japan
| | - Borut Gersak
- 37663 Department of Cardiovascular Surgery, University of Ljubljana School of Medicine, Ljubljana, Slovenia.,Nisteri, Medicine and Research, Ljubljana, Slovenia
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22
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Vondran M, Abt B, Nef H, Rastan AJ. Allegra Transcatheter Heart Valve inside a Degenerated Sutureless Aortic Bioprosthesis. Thorac Cardiovasc Surg Rep 2021; 10:e1-e5. [PMID: 33489712 PMCID: PMC7815337 DOI: 10.1055/s-0040-1721483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Transcatheter aortic valve-in-valve implantation (VIV) is increasingly being used to successfully treat degenerated surgical aortic valve bioprostheses (SAVs). The new self-expanding transcatheter heart valve Allegra, from New Valve Technology with its special implantation mechanism, has proven its safety and feasibility for patients with degenerated SAVs, but it has never been used in the latest-generation sutureless SAV. To the best of our knowledge, this is the first description of the successful VIV of the Allegra prosthesis into a degenerated sutureless SAV, and the procedure yielded an excellent postinterventional hemodynamic results.
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Affiliation(s)
- Maximilian Vondran
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.,Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum, Rotenburg an der Fulda, Germany
| | - Bernd Abt
- Department of Cardiology, Herz-Kreislauf-Zentrum, Rotenburg an der Fulda, Germany
| | - Holger Nef
- Department of Cardiology, Herz-Kreislauf-Zentrum, Rotenburg an der Fulda, Germany.,Department of Cardiology, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Ardawan J Rastan
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.,Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum, Rotenburg an der Fulda, Germany
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23
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Miceli A. Commentary: The confirmation. J Thorac Cardiovasc Surg 2021; 161:935-936. [PMID: 33431205 DOI: 10.1016/j.jtcvs.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Antonio Miceli
- Minimally Invasive Cardiac Department, Istituto Clinico Sant'Ambrogio, Milano, Italy.
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Daeter EJ, van Veghel D, Houterman S, Olsthoorn J, Soliman-Hamad MA. Recent trends in aortic valve interventions: Data of the Netherlands heart registration. J Card Surg 2020; 36:573-581. [PMID: 33355951 DOI: 10.1111/jocs.15265] [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: 07/06/2020] [Revised: 11/10/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Transcatheter aortic valve implantation (TAVI) has evolved from bailout for inoperable patients to an alternative to surgical aortic valve replacement (SAVR) in higher-risk groups. The aim of this study is to describe these clinical trends in TAVI and SAVR in patients with aortic valve disease. METHODS We analyzed data of the Netherlands Heart Registration (NHR) up to 2018 to explore the trends in TAVI and SAVR among 14 cardiac centers in the Netherlands. RESULTS Between 2013 and 2017, a total of 7432 isolated SAVR and 5929 TAVI procedures have been performed. A 43.9% increase in the total number of procedures was observed, mainly due to the considerable increase in the number of TAVI procedures. In 2017, there was a decrease in the number of SAVR procedures. In the TAVI group, 30- and 120-day mortality decreased significantly from 7.2% and 10.6% in 2013 to 3.4% and 5.7% in 2017, respectively. In the SAVR group, 30- and 120-day mortality decreased from 1.7% and 2.9% in 2013 to 1.2% and 1.7% in 2017, respectively. Outcomes showed a significant decrease in vascular complications after TAVI. The risk profile of TAVI patients has changed over time. CONCLUSIONS The recent developments in TAVI have contributed to the increasing numbers of aortic valve interventions in the Netherlands. Mortality rates after SAVR and TAVI decreased as did the rate of complications after TAVI. Furthermore, a trend towards decrease of preoperative risk was observed.
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Affiliation(s)
- Edgar J Daeter
- Netherlands Heart Registration, Utrecht, the Netherlands.,Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Dennis van Veghel
- Netherlands Heart Registration, Utrecht, the Netherlands.,Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Saskia Houterman
- Netherlands Heart Registration, Utrecht, the Netherlands.,Department of Education and Research, Catharina Hospital, Eindhoven, the Netherlands
| | - Jules Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Mohamed A Soliman-Hamad
- Netherlands Heart Registration, Utrecht, the Netherlands.,Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
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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: 6] [Impact Index Per Article: 1.5] [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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Miceli A, Berretta P, Fiore A, Andreas M, Solinas M, Santarpino G, Kappert U, Misfeld M, Savini C, Albertini A, Villa E, Phan K, Fischlein T, Meuris B, Martinelli G, Teoh K, Mignosa C, Shrestha M, Carrel TP, Yan TD, Glauber M, Di Eusanio M. Sutureless and rapid deployment implantation in bicuspid aortic valve: results from the sutureless and rapid-deployment aortic valve replacement international registry. Ann Cardiothorac Surg 2020; 9:298-304. [PMID: 32832411 DOI: 10.21037/acs-2020-surd-33] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Benefits of sutureless and rapid deployment (SURD) bioprostheses in bicuspid aortic valves (BAV) are controversial. The aim of this study is to report the outcomes of patients undergoing aortic valve replacement (AVR) for BAV from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR). Methods Of the 4,636 patients who received primary isolated SURD-AVR between 2007 and 2018, 191 (4.1%) BAV patients underwent AVR with SURD valve. Results Overall 30-day mortality was 1.6%. The Intuity valve was implanted in 53.9% of cases, whereas the Perceval was implanted in 46.1%. Rate of stroke for isolated AVR was 4.2%. No case of endocarditis, thromboembolism, myocardial infarction, valve dislocation or structural valve deterioration was reported in the early phase. Rate of pacemaker implantation and moderate-severe aortic regurgitation (AR) were 7.9% and 3.7%, respectively. Conclusions BAV is not considered a contraindication for the implantation of SURD valves. However, detailed information of aortic root geometry as well as the knowledge of some technical considerations are mandatory for a good outcome.
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Affiliation(s)
- Antonio Miceli
- Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy
| | - Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Solinas
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, Massa, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.,Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Emmanuel Villa
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | | | - Kevin Teoh
- Southlake Regional Health Centre, Ontario, Canada
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | - Malakh Shrestha
- Division of Cardiothoracic Surgery, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Szecel D, Meuris B. Long-term outcome with sutureless valves: 12 years of Perceval experience. Ann Cardiothorac Surg 2020; 9:322-324. [PMID: 32832414 DOI: 10.21037/acs.2020.04.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Delphine Szecel
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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White A, Bozso SJ, Lakey O, Hong Y, Wang S, Nagendran J, Moon MC. Rapid deployment valves versus conventional tissue valves for aortic valve replacement. J Thorac Cardiovasc Surg 2020; 163:2036-2042. [PMID: 32747118 DOI: 10.1016/j.jtcvs.2020.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/25/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Rapid deployment valves have been developed as a means to adjust for limitations in transcatheter aortic valve replacement and surgical aortic valve replacement for the management of aortic valve disease. To date, many studies have shown that although rapid deployment valves facilitate a shorter surgical aortic valve replacement, they offer no clinical benefit. The purpose of this study was to compare the outcomes of rapid deployment valves with conventional surgical aortic valve replacement. METHODS This study was a retrospective review of all patients undergoing tissue aortic valve replacement at a single center. The majority of patients were men and aged more than 60 years. Patients were categorized into 2 groups: (1) rapid deployment valves and (2) conventional sutured valve. Inverse probability treatment weighting method was used to create a cohort of patients with similar baseline characteristics. Kaplan-Meier curves and log-rank tests were used to determine if there were statistically significant differences in outcomes. Primary outcome was all-cause mortality at 30 days, 1 year, and 5 years. RESULTS A total of 2237 patients made up the study population from 2013 to 2019. After inverse probability treatment weighting, there were 295 patients in each group. Shorter cardiopulmonary bypass and crossclamp times were found with the rapid deployment valves. No statistically significant difference was found in the primary and secondary outcomes. There was a significant difference in the rate of permanent pacemaker insertion with a 7% pacemaker rate in the rapid deployment valve group (P < .009). CONCLUSIONS The data suggest that rapid deployment valves offer no benefit in straightforward aortic valve replacement, and further study will help identify which patient population the valve is suited for.
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Affiliation(s)
- Abigail White
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Sabin J Bozso
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Olivia Lakey
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yongzhe Hong
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Shaohua Wang
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Michael C Moon
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
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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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Cinelli M, Schwartz L, Spagnola J, Gulkarov I, Rosell F, Lackey A, Imam M, Schwartz C. Early Structural Deterioration of a Sutureless Bioprosthetic Aortic Valve. Cardiol Res 2020; 11:113-117. [PMID: 32256918 PMCID: PMC7092772 DOI: 10.14740/cr1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Abstract
Sutureless bioprosthetic valves such as the Sorin Perceval S valve (SPV) have been used in patients with aortic stenosis that require surgical aortic valve replacement (SAVR). These prostheses have been marketed on the basis of their rapid implantation techniques with avoidance of sutures and reduced aortic cross-clamp times. We report a case of an early failure of a SPV nearly 4 years after implantation in a 58-year-old woman who was low-risk. While the patient’s symptoms initially improved with SAVR with a sutureless bioprosthetic valve, they progressively worsened as the valve degraded, and the leaflets became increasingly calcified and stenotic ultimately, requiring reoperative SAVR with a St. Jude mechanical valve. This case raises the issue of the lack of much-needed data describing the long-term durability and hemodynamic performance of these valves, particularly in a low-risk patient with excellent functional status. We hope to shed further insight into the lack of long-term studies on patients with SPV to assess their longevity and long-term effectiveness, as well as elucidation of possible prevention and monitoring of these potential complications. The use of newer generation prostheses, although attractive for their ease of implantation, potentially carries higher long-term risk due to shorter durability leading to reintervention to address valve deterioration. This is especially true in low-risk patients who are young and active. Cardiology and cardiothoracic surgery societies need to develop a universal registry with follow-up of all valves in order to track and study the durability of these valves, and to evaluate for incidence of known and potential complications.
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Affiliation(s)
- Michael Cinelli
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Leonard Schwartz
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Jonathan Spagnola
- Division of Cardiology, Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Iosif Gulkarov
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Frank Rosell
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Adam Lackey
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Mohammed Imam
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Charles Schwartz
- Division of Cardiology, Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
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Lamelas J, Alnajar A. Recent advances in devices for minimally invasive aortic valve replacement. Expert Rev Med Devices 2020; 17:201-208. [DOI: 10.1080/17434440.2020.1732812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Joseph Lamelas
- Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed Alnajar
- Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Laricchia A, Mangieri A, Colombo A, Giannini F. Perceval sutureless valve migration treated by valve-in-valve with a CoreValve Evolut Pro. Catheter Cardiovasc Interv 2019; 96:225-227. [PMID: 31785122 DOI: 10.1002/ccd.28635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/01/2019] [Accepted: 11/21/2019] [Indexed: 11/09/2022]
Abstract
In the last years, the use of sutureless devices in frail patients with severe aortic stenosis has increased thanks to their "easier and faster" technique of implantation in comparison to conventional surgery. Results from metanalysis show comparable outcomes in comparison to transcatheter aortic valve replacement (TAVR) in terms of mortality, stroke incidence, and rate of pace-maker implantation. The incidence of para-valvular leak (PVL) is even lower for sutureless devices than for TAVR. The few cases described are generally due to incomplete decalcification or incorrect valve sizing and consequent stent distortion. To our knowledge this is the first case describing PVL with massive aortic regurgitation due to early partial embolization of a Perceval valve and its successfully treatment with valve-in-valve by using a self-expanding TAVR device.
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Affiliation(s)
- Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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Owais T, El Garhy M, Secknus MA, Kuntze T. Implantation of Perceval in Trifecta ring: A new perspective. J Cardiol Cases 2019; 20:172-173. [PMID: 31719938 DOI: 10.1016/j.jccase.2019.07.008] [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: 05/12/2019] [Revised: 06/28/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022] Open
Abstract
We report a case of a 67-year-old woman who underwent an aortic valve replacement with a 23-mm Trifecta prosthesis (St. Jude Medical, St. Paul, MN, USA). We implanted Perceval S (LenoNova, London, UK) after resecting the degenerated leaflets three years later after the first operation. This strategy enabled us to reduce the ischemic time and hence simplify the surgical procedure in addition to providing excellent postoperative hemodynamics. <Learning objective: The Perceval sutureless valve implantation in Trifecta ring is a feasible alternative to transcatheter aortic valve implantation in specific situations.>.
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Affiliation(s)
- Tamer Owais
- Heart Centre, Zentralklinik Bad Berka, Bad Berka, Germany.,Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
| | - Mohammad El Garhy
- Heart Centre, Zentralklinik Bad Berka, Bad Berka, Germany.,Department of Cardiology, Minia University, Minia, Egypt
| | | | - Thomas Kuntze
- Heart Centre, Zentralklinik Bad Berka, Bad Berka, Germany
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Commentary: Thrombocytopenia yes…thrombocytopenia no…that is the question. J Thorac Cardiovasc Surg 2019; 160:70-71. [PMID: 31585751 DOI: 10.1016/j.jtcvs.2019.07.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 01/08/2023]
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36
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Kaur K, Cisneros M, Nathan S, Blair JEA, Balkhy HH. Percutaneous Coronary Intervention following Placement of Sutureless Aortic Bioprostheses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:177-182. [PMID: 30885090 DOI: 10.1177/1556984519836841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Coronary artery disease is often present with aortic stenosis. Although transcatheter aortic valve replacement and minimally invasive surgery provide alternative sternal-sparing options for isolated aortic valve replacement, non-sternotomy treatment of combined coronary artery disease and aortic stenosis has not been well-defined. We report 3 patients who presented with severe aortic stenosis and obstructive coronary artery disease in whom minimally invasive aortic valve replacement using sutureless valve was performed, followed by transradial percutaneous coronary intervention of obstructive coronary lesion. This case series demonstrates a hybrid technique for the treatment of combined severe aortic stenosis and coronary artery disease, which has potential for adequately treating both conditions with minimal risk.
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Affiliation(s)
- Kiran Kaur
- 1 Department of Medicine, Section of Cardiology, Heart and Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Miryea Cisneros
- 1 Department of Medicine, Section of Cardiology, Heart and Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Sandeep Nathan
- 1 Department of Medicine, Section of Cardiology, Heart and Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - John E A Blair
- 1 Department of Medicine, Section of Cardiology, Heart and Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Husam H Balkhy
- 2 Department of Surgery, Section of Cardiothoracic Surgery, Heart and Vascular Center, University of Chicago Medicine, Chicago, IL, USA
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Chang C, Raza S, Altarabsheh SE, Delozier S, Sharma UM, Zia A, Khan MS, Neudecker M, Markowitz AH, Sabik JF, Deo SV. Minimally Invasive Approaches to Surgical Aortic Valve Replacement: A Meta-Analysis. Ann Thorac Surg 2018; 106:1881-1889. [DOI: 10.1016/j.athoracsur.2018.07.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/18/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
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38
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Chauvette V, Mazine A, Bouchard D. Ten-year experience with the Perceval S sutureless prosthesis: lessons learned and future perspectives. J Vis Surg 2018; 4:87. [PMID: 29963376 DOI: 10.21037/jovs.2018.03.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 12/26/2022]
Abstract
Aortic stenosis has traditionally been addressed with surgical aortic valve replacement (AVR). In recent years, several technologies have emerged as alternative treatment methods for aortic valve disease. Among them, the Perceval (LivaNova, London, UK) is a sutureless valve that has been used in clinical practice for over 10 years. It has been implanted in over 20,000 patients worldwide. With nearly 600 Perceval implants since 2011, the Montreal Heart Institute has developed a worldwide expertise with this technology. In this article, we provide an overview of the clinical data currently available in the literature and discuss the lessons we have learned from our experience with the Perceval prosthesis.
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Affiliation(s)
- Vincent Chauvette
- Division of Cardiac Surgery, University of Montreal, Montreal, QC, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Denis Bouchard
- Division of Cardiac Surgery, Montreal Heart Institute, Montreal, QC, Canada
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39
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Lee T, Mittnacht AJ, Itagaki S, Stewart A. Mitral Regurgitation Exacerbation Due to Sutureless Aortic Valve Replacement. Ann Thorac Surg 2018; 105:e103-e105. [DOI: 10.1016/j.athoracsur.2017.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/01/2017] [Indexed: 11/24/2022]
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