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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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Sef D, Thet MS, Klokocovnik T, Luthra S. Early and mid-term outcomes after aortic valve replacement using a novel tissue bioprosthesis: a systematic review. Eur J Cardiothorac Surg 2024; 65:ezae045. [PMID: 38331412 DOI: 10.1093/ejcts/ezae045] [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: 12/02/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES While current data show a clear trend towards the use of bioprosthetic valves during aortic valve replacement (AVR), durability of bioprosthetic valves remains the most important concern. We conducted a 1st systematic review of all available evidence that analysed early and mid-term outcomes after AVR using the Inspiris RESILIA™ bioprosthesis. METHODS A systematic literature search was performed to identify all relevant studies evaluating early and mid-term outcomes after AVR using the Inspiris RESILIA bioprosthesis and including at least 20 patients with no restriction on the publication date. Subgroup meta-analysis was performed to compare Inspiris RESILIA and PERIMOUNT Magna Ease bioprosthesis and to pool the early postoperative mortality and stroke rates. RESULTS A total of 416 studies were identified, of which 15 studies met the eligibility criteria. The studies included a total of 3202 patients with an average follow-up of up to 5.3 years. The average age of patients across the studies was 52.2-75.1 years. Isolated AVR was performed in 39.0-86.4% of patients. In-hospital or 30-day postoperative mortality was 0-2.8%. At the mid-term follow-up, freedom from all-cause mortality was up to 85.4%. Among studies with mid-term follow-up, trace/mild paravalvular leak was detected in 0-3.0%, while major paravalvular leak was found only in up to 2.0% of patients. No statistically significant differences in terms of mortality (P = 0.98, odds ratio 1.02, 95% confidence interval 0.36-2.83) and stroke (P = 0.98, odds ratio 1.01, 95% confidence interval 0.38-2.73) between the Inspiris RESILIA bioprosthesis and PERIMOUNT Magna Ease bioprosthesis were observed in the subgroup meta-analysis. CONCLUSIONS Mid-term data on the safety and haemodynamic performance of the novel aortic bioprosthesis are encouraging. Further comparative studies with other bioprostheses and longer follow-up are still required to endorse durability and safety of the novel bioprosthesis.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, University Hospitals of Leicester, Leicester, UK
| | - Myat Soe Thet
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | | | - Suvitesh Luthra
- Department of Cardiac Surgery, Wessex Cardiothoracic Centre, University Hospital of Southampton, Southampton, UK
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Ilcheva L, Risteski P, Tudorache I, Häussler A, Papadopoulos N, Odavic D, Rodriguez Cetina Biefer H, Dzemali O. Beyond Conventional Operations: Embracing the Era of Contemporary Minimally Invasive Cardiac Surgery. J Clin Med 2023; 12:7210. [PMID: 38068262 PMCID: PMC10707549 DOI: 10.3390/jcm12237210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 06/26/2024] Open
Abstract
Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures.
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Affiliation(s)
- Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
| | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
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Pommert NS, Zhang X, Puehler T, Seoudy H, Huenges K, Schoettler J, Haneya A, Friedrich C, Sathananthan J, Sellers SL, Meier D, Mueller OJ, Saad M, Frank D, Lutter G. Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique. J Clin Med 2023; 12:5211. [PMID: 37629253 PMCID: PMC10455155 DOI: 10.3390/jcm12165211] [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: 06/28/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is now a well-established therapeutic option in an elderly high-risk patient cohort with aortic valve disease. Although most commonly performed via a transfemoral route, alternative approaches for TAVI are constantly being improved. Instead of the classical mini-sternotomy, it is possible to achieve a transaortic access via a right anterior mini-thoracotomy in the second intercostal space. We describe our experience with this sternum- and rib-sparing technique in comparison to the classical transaortic approach. METHODS Our retrospective study includes 173 patients who were treated in our institution between January 2017 and April 2020 with transaortic TAVI via either upper mini-sternotomy or intercostal thoracotomy. The primary endpoint was 30-day mortality, and secondary endpoints were defined as major postoperative complications that included admission to the intensive care unit and overall hospital stay, according to the Valve Academic Research Consortium 3. RESULTS Eighty-two patients were treated with TAo-TAVI by upper mini-sternotomy, while 91 patients received the intercostal approach. Both groups were comparable in age (mean age: 82 years) and in the proportion of female patients. The intercostal group had a higher rate of peripheral artery disease (41% vs. 22%, p = 0.008) and coronary artery disease (71% vs. 40%, p < 0.001) with a history of percutaneous coronary intervention or coronary artery bypass grafting, resulting in significantly higher preinterventional risk evaluation (EuroScore II 8% in the intercostal vs. 4% in the TAo group, p = 0.005). Successful device implantation and a reduction of the transvalvular gradient were achieved in all cases with a significantly lower rate of trace to mild paravalvular leakage in the intercostal group (12% vs. 33%, p < 0.001). The intercostal group required significantly fewer blood transfusions (0 vs. 2 units, p = 0.001) and tended to require less reoperation (7% vs. 15%, p = 0.084). Hospital stays (9 vs. 12 d, p = 0.011) were also shorter in the intercostal group. Short- and long-term survival in the follow-up showed comparable results between the two approaches (30-day, 6-month- and 2-year mortality: 7%, 23% and 36% in the intercostal vs. 9%, 26% and 33% in the TAo group) with acute kidney injury (AKI) and reintubation being independent risk factors for mortality. CONCLUSIONS Transaortic TAVI via an intercostal access offers a safe and effective treatment of aortic valve stenosis.
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Affiliation(s)
- Nina Sophie Pommert
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
- DZHK—German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany;
| | - Xiling Zhang
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
- DZHK—German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany;
| | - Hatim Seoudy
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (H.S.); (O.J.M.); (M.S.)
| | - Katharina Huenges
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Jan Schoettler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Christine Friedrich
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Janarthanan Sathananthan
- Cardiovascular Translational Laboratory, Providence Research & UBC Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada; (J.S.); (S.L.S.); (D.M.)
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- UBC Centre for Cardiovascular Innovation, Vancouver, BC V6Z 1Y6, Canada
| | - Stephanie L. Sellers
- Cardiovascular Translational Laboratory, Providence Research & UBC Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada; (J.S.); (S.L.S.); (D.M.)
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- UBC Centre for Cardiovascular Innovation, Vancouver, BC V6Z 1Y6, Canada
| | - David Meier
- Cardiovascular Translational Laboratory, Providence Research & UBC Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada; (J.S.); (S.L.S.); (D.M.)
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- UBC Centre for Cardiovascular Innovation, Vancouver, BC V6Z 1Y6, Canada
| | - Oliver J. Mueller
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (H.S.); (O.J.M.); (M.S.)
| | - Mohammed Saad
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (H.S.); (O.J.M.); (M.S.)
| | - Derk Frank
- DZHK—German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany;
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (H.S.); (O.J.M.); (M.S.)
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
- DZHK—German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany;
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Masraf H, Sef D, Chin SL, Hunduma G, Trkulja V, Miskolczi S, Velissaris T, Luthra S. Long-Term Survival among Octogenarians Undergoing Aortic Valve Replacement with or without Simultaneous Coronary Artery Bypass Grafting: A 22-Year Tertiary Single-Center Experience. J Clin Med 2023; 12:4841. [PMID: 37510956 PMCID: PMC10381828 DOI: 10.3390/jcm12144841] [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: 07/04/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The impact of concomitant coronary artery bypass grafting (CABG) on aortic valve replacement (AVR) in octogenarians is still debated. We analyzed the characteristics and long-term survival of octogenarians undergoing isolated AVR and AVR + CABG. METHODS All octogenarians who consecutively underwent AVR with or without concomitant CABG at our tertiary cardiac center between 2000 and 2022 were included. Patients with redo, emergent, or any other concomitant procedures were excluded. The primary endpoints were 30-day and long-term survival. The secondary endpoints were early postoperative outcomes and determinants of long-term survival. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of 30-day mortality, and Cox regression analysis was performed for predictors of adverse long-term survival. RESULTS A total of 1011 patients who underwent AVR (83.0 [81.0-85.0] years, 42.0% males) and 1055 with AVR + CABG (83.0 [81.2-85.4] years, 66.1% males) were included in our study. Survival at 30 days and at 1, 3, and 5 years in the AVR group was 97.9%, 91.5%, 80.5%, and 66.2%, respectively, while in the AVR + CABG group it was 96.2%, 89.6%, 77.7%, and 64.7%, respectively. There was no significant difference in median postoperative survival between the AVR and AVR + CABG groups (7.1 years [IQR: 6.7-7.5] vs. 6.6 years [IQR: 6.3-7.2], respectively, p = 0.21). Significant predictors of adverse long-term survival in the AVR group included age (hazard ratio (HR): 1.09; 95% CI: 1.06-1.12, p < 0.001), previous MI (HR: 2.08; 95% CI: 1.32-3.28, p = 0.002), and chronic kidney disease (HR 2.07; 95% CI: 1.33-3.23, p = 0.001), while in the AVR + CABG group they included age (HR: 1.06; 95% CI: 1.04-1.10, p < 0.001) and diabetes mellitus (HR: 1.48; 95% CI: 1.15-1.89, p = 0.002). Concomitant CABG was not an independent risk factor for adverse long-term survival (HR: 0.89; 95% CI: 0.77-1.02, p = 0.09). CONCLUSIONS The long-term survival of octogenarians who underwent AVR or AVR + CABG was similar and was not affected by adding concomitant CABG. However, octogenarians who underwent concomitant CABG with AVR had significantly higher in-hospital mortality. Each decision should be discussed within the heart team.
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Affiliation(s)
- Hannah Masraf
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Davorin Sef
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Sirr Ling Chin
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Gabriel Hunduma
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | | | - Szabolcs Miskolczi
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Theodore Velissaris
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
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Sef D, Krajnc M, Klokocovnik T. Reply to Özahn et al.: "Challenges in sutureless aortic valve implantation with minimal invasive technique". J Card Surg 2022; 37:3457-3458. [PMID: 35801500 DOI: 10.1111/jocs.16757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery and Transplant Unit, Royal Brompton and Harefield Hospitals, Harefield Hospital, London, UK
| | - Martina Krajnc
- Department of Cardiovascular Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Tomislav Klokocovnik
- Department of Cardiac Surgery and Transplant Unit, Royal Brompton and Harefield Hospitals, Harefield Hospital, London, UK
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Sef D, Bahrami T, Raja SG, Klokocovnik T. Current trends in minimally invasive valve‐sparing aortic root replacement—Best available evidence. J Card Surg 2022; 37:1684-1690. [PMID: 35348237 DOI: 10.1111/jocs.16453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/20/2022] [Accepted: 03/05/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Toufan Bahrami
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Shahzad G. Raja
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Tomislav Klokocovnik
- Department of Cardiovascular Surgery University Hospital Center Ljubljana Ljubljana Slovenia
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Condello I, Nasso G, Vernice A, Speziale G. Protek Duo cannula potential advantages in minimally invasive aortic valve replacement. J Card Surg 2022; 37:1130. [DOI: 10.1111/jocs.16285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ignazio Condello
- Department of Cardiovascular Surgery Anthea Hospital, GVM Care & Research Bari Italy
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery Anthea Hospital, GVM Care & Research Bari Italy
| | - Alessandro Vernice
- Department of Cardiovascular Surgery Anthea Hospital, GVM Care & Research Bari Italy
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery Anthea Hospital, GVM Care & Research Bari Italy
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Özhan A, Bademci MŞ, Kocaaslan C, Bayraktar FA, Karamanlı DC, Öztekin A, Aydın E. Challenges in sutureless aortic valve implantation with minimal invasive technique. J Card Surg 2021; 37:256. [PMID: 34775635 DOI: 10.1111/jocs.16141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Abdulkerim Özhan
- Department of Cardiovascular Surgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Mehmet Şenel Bademci
- Department of Cardiovascular Surgery, İstanbul Medeniyet University Faculty of Medicine, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Cemal Kocaaslan
- Department of Cardiovascular Surgery, İstanbul Medeniyet University Faculty of Medicine, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Fatih Avni Bayraktar
- Department of Cardiovascular Surgery, İstanbul Medeniyet University Faculty of Medicine, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Defne Cansu Karamanlı
- Department of Cardiovascular Surgery, İstanbul Medeniyet University Faculty of Medicine, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Ahmet Öztekin
- Department of Cardiovascular Surgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Ebuzer Aydın
- Department of Cardiovascular Surgery, İstanbul Medeniyet University Faculty of Medicine, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
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Bozhinovska M, Jenko M, Stupica GT, Klokočovnik T, Kšela J, Jelenc M, Podbregar M, Fabjan A, Šoštarič M. Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study. J Cardiothorac Surg 2021; 16:142. [PMID: 34030698 PMCID: PMC8142614 DOI: 10.1186/s13019-021-01509-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Recently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation. Methods Trans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke’s Cognitive Examination Revised Test before and 30 days after surgical procedure. Results A total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8 ± 14.4 vs.72 ± 5.84, p = 0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p = 0.002) and had higher body surface area (1.98 ± 0.167 vs. 1.83 ± 0.178, p = 0.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ± 24 vs. 134 ± 30 min, p < 0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677–10.60, p = 0.027). Addenbrooke’s Cognitive Examination Revised Test score decreased equivalently in both groups (p = 0.630) (MS: 85.2 ± 9.6 vs. 82.9 ± 11.4, p = 0.012; MT: 85.2 ± 9.6 vs. 81.3 ± 8.8, p = 0.001). Conclusion There is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline. Trial registry number clinicaltrials.gov, NCT02697786 14. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01509-8.
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Affiliation(s)
- Marija Bozhinovska
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia
| | - Matej Jenko
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia
| | - Gordana Taleska Stupica
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia
| | - Tomislav Klokočovnik
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Juš Kšela
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matija Jelenc
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matej Podbregar
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Department of Internal Intensive Medicine, General and Teaching Hospital, Celje, Slovenia
| | - Andrej Fabjan
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Šoštarič
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia. .,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
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Fatehi Hassanabad A, Aboelnazar N, Maitland A, Holloway DD, Adams C, Kent WDT. Right anterior mini thoracotomy approach for isolated aortic valve replacement: Early outcomes at a Canadian center. J Card Surg 2021; 36:2365-2372. [PMID: 34002895 DOI: 10.1111/jocs.15571] [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: 03/18/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The goal of this manuscript was to report the clinical outcomes of the initial series of 100 consecutive Right Anterior Mini Thoracotomy (RAMT) aortic valve replacement (AVR) implantations at a Canadian Center. METHODS This retrospective study reported the clinical outcomes of the first 100 patients who underwent the RAMT approach for isolated surgical AVR in Calgary, Canada, between 2016 and 2020. Primary outcomes were death within 30 days of surgery and disabling stroke. Secondary outcomes included surgical times, the need for permanent pacemaker (PPM), incidence of postoperative blood transfusion in the intensive care unit (ICU), postsurgical atrial fibrillation (AF), length of ICU/hospital stay, postsurgical AF, residual paravalvular leak (PVL), postoperative transvalvular gradient, need for postsurgical intravenous opioids, duration of invasive ventilation in the ICU, and chest tube output in the first 12 h postsurgery. RESULTS In this study, 54 patients were male, and the average age of the cohort was 72 years. Mortality within 30 days of surgery was 1% with no disabling postoperative strokes. Mean cardiopulmonary bypass and cross clamp was 84 and 55 min, respectively. PPM rate was 3%, incidence of blood transfusion in the ICU was 4%, and the rate of postoperative AF was 23%. Median length of ICU and hospital stay was 1 and 5 days, respectively. Rate of mild or greater residual PVL was 3%, while the average residual transvalvular mean gradient was 8.5 mmHg. CONCLUSION The sternum-sparing RAMT approach can be safely integrated into surgical practice as a minimally invasive alternative for isolated AVR, and can reduce postoperative bleeding and narcotic requirements.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nader Aboelnazar
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Andrew Maitland
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel D Holloway
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - William D T Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
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