1
|
Lamberigts M, Szecel D, Rega F, Verbrugghe P, Dubois C, Meuris B. Sutureless aortic valves in isolated and combined procedures: Thirteen years of experience in 784 patients. J Thorac Cardiovasc Surg 2024; 167:1724-1732.e1. [PMID: 36404146 DOI: 10.1016/j.jtcvs.2022.09.053] [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: 04/01/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcome and experience of the Perceval sutureless valve at our institution (UZ Leuven). METHODS Between 2007 and 2019, 784 patients underwent sutureless aortic valve replacement using the Perceval valve (isolated or combined with other procedures). We performed a retrospective analysis of the postoperative and follow-up data. RESULTS Mean age was 78 years with a median European System for Cardiac Operative Risk Evaluation II score of 4.2% (interquartile range, 2.6%-7.2%). Isolated aortic valve replacement accounted for 45% of cases; 30% of cases were aortic valve replacement in combination with coronary artery bypass grafting and the remaining 25% were other combined procedures. The median crossclamp times were 38 minutes in single aortic valve replacement, 70 minutes in cases with coronary artery bypass grafting, and 89 minutes in multiple valve cases. Device success was 99.1% and in-hospital mortality was 3.3%. Postoperative stroke or transient ischemic attack occurred in 1.9% of patients and 1% of patients had a new need for dialysis after surgery and median survival time was 7.0 years with a cumulative follow-up of 2797.8 patient-years. The 1-, 5-, and 10-year freedom from reintervention were 99%, 97%, and 94%, respectively. CONCLUSIONS These data represent the longest follow-up available, to our knowledge, for the Perceval sutureless valve. We observed favorable early outcomes, and low rates of early mortality, stroke, and other major complications. Valve durability is promising with low rates of valve degeneration and a limited need for reintervention.
Collapse
Affiliation(s)
| | | | - Filip Rega
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | | | | | - Bart Meuris
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Alaklabi AM, Abdul Rab S, Sabbah BN, Maklad AE, Dokollari A, Van den Eynde J, Pompeu Sa M, Arjomandi Rad A, Ahsan MR, Fatehi Hassanabad A. Innovations in Aortic Valve Replacement: A Comprehensive Overview of the Intuity Rapid Deployment Valve. Cardiol Rev 2024:00045415-990000000-00210. [PMID: 38334371 DOI: 10.1097/crd.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Rapid deployment/sutureless (RDS) valves have recently emerged as an innovative surgical solution, providing an alternative to traditional methods of surgical aortic valve replacement (SAVR) by eliminating the need for suture placement and tying. This innovation leads to a reduction in aortic crossclamp and cardiopulmonary bypass times, enhancing the efficiency of the procedure. Among the 2 available RDS valves, the Edwards Intuity valve in particular has been demonstrated to be a particularly promising substitute in the field of SAVR. The Intuity valve distinguishes itself from other RDS and conventional valves by yielding superior outcomes, such as a significant reduction in mortality, increase in the longevity of the valve, and a marked decrease in both mean and peak transvalvular pressure gradients. These benefits collectively contribute to its appeal as a favorable new solution. However, further investigation is needed to conclusively determine the long-term outcomes and safety of RDS valves. Nevertheless, the utilization of the Intuity valve presents an exciting solution to the existing limitations of conventional and minimally invasive SAVR, especially for patients afflicted with severe aortic stenosis.
Collapse
Affiliation(s)
| | - Saleha Abdul Rab
- From the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Belal N Sabbah
- From the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Aleksander Dokollari
- Section of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Michel Pompeu Sa
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA
- UPMC Heart and Vascular Institute, Pittsburgh, PA
| | | | - Muhammad Rauf Ahsan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| |
Collapse
|
4
|
Hosoba S, Ito T, Mori M, Kato R, Kajiyama K, Maeda S, Nakai Y, Morishita Y. Endoscopic Aortic Valve Replacement: Initial Outcomes of Isolated and Concomitant Surgery. Ann Thorac Surg 2023; 116:744-749. [PMID: 37276923 DOI: 10.1016/j.athoracsur.2023.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The applicability of totally endoscopic surgical aortic valve replacement (AVR) in multivalve operations is unknown. This study describes an approach and perioperative outcomes of totally endoscopic isolated and concomitant AVR using various valve types. METHODS A total of 216 patients (114 male; mean age, 71.3 ± 11.3 years) underwent totally endoscopic AVR from May 2017 to October 2022 in a tertiary care center. The 3-port technique was used: a 3- to 4-cm main port without rib spreading, a 10-mm 3-dimensional endoscopic port, and a 5-mm left-hand port with femoral cannulations. Sutures were hand tied with a knot pusher. Descriptive analyses compared perioperative outcomes between patients with or without concomitant procedures. RESULTS Of 216 patients, concomitant surgery was performed in 33 (15.2%) patients. Of the 33, 21 (63.6%) had a concomitant mitral procedure. A stented bioprosthesis was implanted in 165 (76.3%) patients, a mechanical valve in 22 (10.2%) patients, and a rapid deployment or sutureless valve in 29 (13.4%) patients. Median operation time and aortic cross-clamp time were 175 minutes (interquartile range; 150-194 minutes) and 78 minutes (interquartile range; 67-92 minutes) for isolated AVR, respectively. Thirty-day mortality occurred in 1 patient (0.5%). Two patients (0.9%) had conversion to sternotomy. Major neurologic events occurred in 3 patients (1.4%). The major adverse event rate was similar between patients with or without concomitant procedures. CONCLUSIONS Endoscopic AVR can safely address concomitant valve diseases.
Collapse
Affiliation(s)
- Soh Hosoba
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan.
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Makoto Mori
- Division of Cardiothoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Riku Kato
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Koh Kajiyama
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Shogo Maeda
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yuji Nakai
- Department of Clinical Engineering, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yoshihiro Morishita
- Department of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| |
Collapse
|
5
|
Watanabe T, Kitahara H, Shah AP, Blair J, Nathan S, Balkhy HH. Sternal-Sparing Surgical Options in Combined Aortic Valve and Coronary Artery Disease: Proof of Concept. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:346-351. [PMID: 37458227 DOI: 10.1177/15569845231185566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The standard management of concomitant aortic valve (AV) and coronary artery disease has been coronary artery bypass and AV replacement (AVR). With the advent of minimally invasive options, many isolated lesions have been successfully managed using a sternal-sparing approach. In our institution, patients with isolated AV disease are offered minimally invasive surgical or transcatheter AVR, and those with isolated coronary artery disease are routinely managed with robotic totally endoscopic coronary artery bypass or percutaneous coronary intervention. Various combinations of these techniques can be used when a sternal-sparing posture is desired because of patient risk or preference. The aim of this study was to review the outcomes in patients with combined AV and coronary disease who were managed using sternal-sparing approaches. METHODS We reviewed the records of 10 patients in our minimally invasive surgical database who presented with concomitant AV and coronary artery disease and underwent combined sternal-sparing management of these 2 lesions using various combinations of minimally invasive approaches. RESULTS Four patients had totally endoscopic coronary artery bypass and minimally invasive AVR at the same time, 2 patients underwent transcatheter AVR followed by totally endoscopic coronary artery bypass, and 4 patients underwent minimally invasive AVR with percutaneous coronary intervention. There was no 30-day mortality. The duration of postoperative surgical hospital stay was 3.1 ± 0.9 days. CONCLUSIONS Sternal-sparing approaches in combined AV and coronary artery disease are feasible with patient-specific treatment selection of minimally invasive techniques.
Collapse
Affiliation(s)
- Tatsuya Watanabe
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Hiroto Kitahara
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Atman P Shah
- Division of Cardiology University of Chicago Medicine, IL, USA
| | - John Blair
- Division of Cardiology University of Chicago Medicine, IL, USA
| | - Sandeep Nathan
- Division of Cardiology University of Chicago Medicine, IL, USA
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| |
Collapse
|
6
|
Zubarevich A, Amanov L, Arjomandi Rad A, Beltsios ET, Szczechowicz M, Osswald A, Ruhparwar A, Weymann A. Single-Center Real-World Experience with Sutureless Aortic Valve Prosthesis in Isolated and Combined Procedures. J Clin Med 2023; 12:4163. [PMID: 37373856 DOI: 10.3390/jcm12124163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Due to their favourable hemodynamic performance and the ability to enable minimally invasive access procedures, sutureless aortic valve prostheses have found their place in the armamentarium of cardiothoracic surgeons. In this study, we sought to review our institutional experience of sutureless aortic valve replacement (SU-AVR). METHODS We carried out a retrospective analysis of 200 consecutive patients who underwent an SU-AVR with a Perceval valve between December 2019 and February 2023. RESULTS The mean age of patients was 69.3 ± 8.1 years, and patients showed a moderate-risk profile with a mean logistic EuroSCORE-II of 5.2 ± 8.1%. An isolated SU-AVR was performed in 85 (42.5%) patients, concomitant CABG was performed in 75 (37.5%) and 40 patients (20%) underwent a multivalve procedure involving SU-AVR. The cardiopulmonary bypass (CPB) and cross-clamp (CC) times were 82.1 ± 35.1 and 55.5 ± 27.8 min, respectively. In-hospital, 30-day, 6-month and 1-year mortality rates were 4.5%, 6.5%, 7.5% and 8.2%, respectively. The postoperative transvalvular mean pressure gradient was 6.3 ± 1.6 mmHg and stayed stable over the follow-up time. We reported no cases of paravalvular leakage, and the incidence of stroke was 0.5%. CONCLUSIONS With their favourable hemodynamic performance and shorter CC and CPB times, sutureless aortic valve prostheses facilitate minimally invasive access surgery, being a safe and durable promising approach for the surgical AVR.
Collapse
Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
| | - Lukman Amanov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
| | | | - Eleftherios T Beltsios
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| |
Collapse
|
7
|
Jolliffe J, Moten S, Tripathy A, Skillington P, Tatoulis J, Muneretto C, Di Bacco L, Galvao HBF, Goldblatt J. Perceval valve intermediate outcomes: a systematic review and meta-analysis at 5-year follow-up. J Cardiothorac Surg 2023; 18:129. [PMID: 37041628 PMCID: PMC10091543 DOI: 10.1186/s13019-023-02273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES New technologies for the treatment of Aortic Stenosis are evolving to minimize risk and treat an increasingly comorbid population. The Sutureless Perceval Valve is one such alternative. Whilst short-term data is promising, limited mid-term outcomes exist, until now. This is the first systematic review and meta-analysis to evaluate mid-term outcomes in the Perceval Valve in isolation. METHODS A systematic literature review of 5 databases was performed. Articles included evaluated echocardiographic and mortality outcomes beyond 5 years in patients who had undergone Perceval Valve AVR. Two reviewers extracted and reviewed the articles. Weighted estimates were performed for all post-operative and mid-term data. Aggregated Kaplan Meier curves were reconstructed from digitised images to evaluate long-term survival. RESULTS Seven observational studies were identified, with a total number of 3196 patients analysed. 30-day mortality was 2.5%. Aggregated survival at 1, 2, 3, 4 and 5 years was 93.4%, 89.4%, 84.9%, 82% and 79.5% respectively. Permanent pacemaker implantation (7.9%), severe paravalvular leak (1.6%), structural valve deterioration (1.5%), stroke (4.4%), endocarditis (1.6%) and valve explant (2.3%) were acceptable at up to mid-term follow up. Haemodynamics were also acceptable at up mid-term with mean-valve gradient (range 9-13.6 mmHg), peak-valve gradient (17.8-22.3 mmHg) and effective orifice area (1.5-1.8 cm2) across all valve sizes. Cardiopulmonary bypass (78 min) and Aortic cross clamp times (52 min) were also favourable. CONCLUSION To our knowledge, this represents the first meta-analysis to date evaluating mid-term outcomes in the Perceval Valve in isolation and demonstrates good 5-year mortality, haemodynamic and morbidity outcomes. KEY QUESTION What are the mid-term outcomes at up to 5 years follow up in Perceval Valve Aortic Valve Replacement? KEY FINDINGS Perceval Valve AVR achieves 80% freedom from mortality at 5 years with low valve gradients and minimal morbidity. KEY OUTCOMES Perceval Valve Aortic Valve Replacement has acceptable mid-term mortality, durability and haemodynamic outcomes.
Collapse
Affiliation(s)
- Jarrod Jolliffe
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia.
| | - Simon Moten
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Amit Tripathy
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Peter Skillington
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - James Tatoulis
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | | | - Lorenzo Di Bacco
- School of Cardiac Surgery, University of Brescia, Brescia, Italy
| | | | - John Goldblatt
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| |
Collapse
|
8
|
Sakata T, De La Pena C, Ohira S. Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations. Vasc Health Risk Manag 2023; 19:169-180. [PMID: 37016696 PMCID: PMC10066891 DOI: 10.2147/vhrm.s374410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Sutureless or rapid deployment valves in the setting of aortic valve replacement (AVR) is an emerging surgical technique using the transcatheter valve technology, which may lead to reduction in cross-clamp time and potentially better hemodynamics compared to a stented bioprosthetic valve. The absence of subannular pledgets results to excellent hemodynamic performance with reduced turbulent flow and larger effective orifice area. However, complications from both surgical and transcatheter AVR may still occur and impact survival. The incidence of paravalvular leakage and permanent pacemaker implantation are not low. Although technical modifications can improve these outcomes, there is a learning curve effect. Therefore, technical and anatomical considerations as well as better patient selection are paramount for better outcomes. In this review, we discuss the use of sutureless or rapid deployment valves in setting of (1) complex procedures, (2) minimally invasive AVR, and (3) small aortic annulus. The advantage of sutureless or rapid deployment valves in terms of mortality remains to be clarified; therefore, it is necessary to accumulate long-term outcomes in an appropriate patient cohort.
Collapse
Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corazon De La Pena
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Correspondence: Suguru Ohira, Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Macy Pavilion, Valhalla, NY, 10595, USA, Tel +1 404 234 5433, Email
| |
Collapse
|
9
|
Niinami H, Sawa Y, Shimokawa T, Domoto S, Nakamura Y, Sakaguchi T, Ito T, Toda K, Amano A, Gersak B. 1-year outcomes of patients implanted with the Perceval sutureless valve: the Japanese post-marketing surveillance study. Heart Vessels 2023; 38:949-956. [PMID: 36773041 DOI: 10.1007/s00380-023-02240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023]
Abstract
Sutureless offers an alternative to standard valves in surgical aortic valve replacement (SAVR). We sought to confirm the efficacy and safety of the Perceval sutureless valve in Japanese patients. Prospective observational study of 204 patients who underwent SAVR with Perceval at 19 sites in Japan between March and December 2019. The primary outcomes were 30-day mortality and postoperative complications; the secondary outcome was all-cause mortality at 1 year. Efficacy outcomes were changed in New York Heart Association (NYHA) class, pressure gradients, effective orifice area (EOA), EOA indexed to body surface area (EOAi) and severity of aortic regurgitation. Mean age was 77.7 years, 62.7% were female. Procedural success rate was 99.0%. The median cross-clamp and cardiopulmonary bypass times were 68.0 and 108 min. Perceval size S and M were implanted in 95 (46.6%) and in 76 (37.3%) of patients, respectively. The 30-day and late mortality rate were 0.5% and 4.4%, while the new permanent pacemaker implantation rate was 4.4%. Mean pressure gradient was 13.0 mmHg at discharge, reaching 11.0 mmHg at 1 year; while the mean EOA was 1.5 cm2 at discharge remaining stable up to 1 year. No moderate or severe leakages were present at discharge or at 1 year. NYHA class improved by ≥ 1 level in 55.1% of the patients at discharge and in 69.4% of the patients at 1 year. 1-year outcomes of SAVR with the Perceval sutureless valve in Japanese patients were favorable. This valve offers a promising alternative to conventional biological AVR in this Japanese population.
Collapse
Affiliation(s)
- Hiroshi Niinami
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University Tokyo, Tokyo, Japan.
| | - Yoshiki Sawa
- Cardiovascular Surgery, Osaka University, Suita, Japan
| | - Tomoki Shimokawa
- Cardiovascular Surgery, Sakakibara Heart Institute Tokyo/Teikyo University, Fuchu, Japan
| | - Satoru Domoto
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University Tokyo, Tokyo, Japan
| | | | - Taichi Sakaguchi
- Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Toshiaki Ito
- Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Koichi Toda
- Cardiovascular Surgery, Osaka University, Suita, Japan
| | - Atsushi Amano
- Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Borut Gersak
- Medical Faculty/Nisteri, Medicine and Research, University of Ljubljana, Phoenix, AZ, USA
| |
Collapse
|
10
|
Randomized controlled trial between conventional versus sutureless bioprostheses for aortic valve replacement: Impact of mini and full sternotomy access at 1-year follow-up. Int J Cardiol 2022; 368:56-61. [DOI: 10.1016/j.ijcard.2022.08.012] [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: 05/04/2022] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022]
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Fabre O, Radutoiu M, Carjaliu I, Rebet O, Gautier L, Hysi I. Recent improvement in operative techniques lead to lower pacemaker rate after Perceval implant. Interact Cardiovasc Thorac Surg 2022; 35:6617842. [PMID: 35751610 PMCID: PMC9295764 DOI: 10.1093/icvts/ivac182] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/07/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Decrease in the pacemaker rate after Perceval implants in the last 5 years. The left Y-axis shows the percent of permanent cardiac pacemakers implanted. The right Y-axis (in green) shows the number of Perceval valves implanted. ![]()
Collapse
Affiliation(s)
- Olivier Fabre
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Mihai Radutoiu
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Ionut Carjaliu
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Olivier Rebet
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Laurence Gautier
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Ilir Hysi
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| |
Collapse
|
13
|
Fischlein T, Caporali E, Asch FM, Vogt F, Pollari F, Folliguet T, Kappert U, Meuris B, Shrestha ML, Roselli EE, Bonaros N, Fabre O, Corbi P, Troise G, Andreas M, Pinaud F, Pfeiffer S, Kueri S, Tan E, Voisine P, Girdauskas E, Rega F, García-Puente J, De Kerchove L, Lorusso R. Hemodynamic Performance of Sutureless vs. Conventional Bioprostheses for Aortic Valve Replacement: The 1-Year Core-Lab Results of the Randomized PERSIST-AVR Trial. Front Cardiovasc Med 2022; 9:844876. [PMID: 35252408 PMCID: PMC8894864 DOI: 10.3389/fcvm.2022.844876] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveSutureless aortic valves are an effective option for aortic valve replacement (AVR) showing non-inferiority to standard stented aortic valves for major cardiovascular and cerebral events at 1-year. We report the 1-year hemodynamic performance of the sutureless prostheses compared with standard aortic valves, assessed by a dedicated echocardiographic core lab.MethodsPerceval Sutureless Implant vs. Standard Aortic Valve Replacement (PERSIST-AVR) is a prospective, randomized, adaptive, open-label trial. Patients undergoing AVR, as an isolated or combined procedure, were randomized to receive a sutureless [sutureless aortic valve replacement (Su-AVR)] (n = 407) or a stented sutured [surgical AVR (SAVR)] (n = 412) bioprostheses. Site-reported echocardiographic examinations were collected at 1 year. In addition, a subgroup of the trial population (Su-AVR n = 71, SAVR = 82) had a complete echocardiographic examination independently assessed by a Core Lab (MedStar Health Research Institute, Washington D.C., USA) for the evaluation of the hemodynamic performance.ResultsThe site-reported hemodynamic data of stented valves and sutureless valves are stable and comparable during follow-up, showing stable reduction of mean and peak pressure gradients through one-year follow-up (mean: 12.1 ± 6.2 vs. 11.5 ± 4.6 mmHg; peak: 21.3 ± 11.4 vs. 22.0 ± 8.9 mmHg). These results at 1-year are confirmed in the subgroup by the core-lab assessed echocardiogram with an average mean and peak gradient of 12.8 ± 5.7 and 21.5 ± 9.1 mmHg for Su-AVR, and 13.4 ± 7.7 and 23.0 ± 13.0 mmHg for SAVR. The valve effective orifice area was 1.3 ± 0.4 and 1.4 ± 0.4 cm2 at 1-year for Su-AVR and SAVR. These improvements are observed across all valve sizes. At 1-year evaluation, 91.3% (n = 42) of patients in Su-AVR and 82.3% in SAVR (n = 51) groups were free from paravalvular leak (PVL). The rate of mild PVL was 4.3% (n = 2) in Su-AVR and 12.9% (n = 8) in the SAVR group. A similar trend is observed for central leak occurrence in both core-lab assessed echo groups.ConclusionAt 1-year of follow-up of a PERSIST-AVR patient sub-group, the study showed comparable hemodynamic performance in the sutureless and the stented-valve groups, confirmed by independent echo core lab. Perceval sutureless prosthesis provides optimal sealing at the annulus with equivalent PVL and central regurgitation extent rates compared to sutured valves. Sutureless valves are therefore a reliable and essential technology within the modern therapeutic possibilities to treat aortic valve disease.
Collapse
Affiliation(s)
- Theodor Fischlein
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
- *Correspondence: Theodor Fischlein
| | - Elena Caporali
- Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Department of Cardiac Surgery, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
- Elena Caporali
| | - Federico M. Asch
- MedStar Health Research Institute, Washington Hospital Center, Washington D.C., DC, United States
| | - Ferdinand Vogt
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Thierry Folliguet
- Cardiac Surgery Unit, Hôpital Henri Mondor, Université Paris 12, Créteil, France
| | - Utz Kappert
- Herzzentrum Dresden GmbH Universitätsklinik, Dresden, Germany
| | - Bart Meuris
- Cardiac Surgery Unit, UZ Gasthuisberg Leuven, Leuven, Belgium
| | - Malakh L. Shrestha
- Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Eric E. Roselli
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Olivier Fabre
- Lens Hospital and Bois Bernard Private Hospital, Lens, France
| | | | - Giovanni Troise
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Frederic Pinaud
- Department of Cardiac Surgery, University Hospital Angers, Angers, France
| | - Steffen Pfeiffer
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Sami Kueri
- University Heart Center Freiburg, Bad Krozingen, Germany
| | - Erwin Tan
- Catharina Ziekenhuis, Eindhoven, Netherlands
| | - Pierre Voisine
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, QC, Canada
| | - Evaldas Girdauskas
- University Heart Center Hamburg, Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg, Germany
| | - Filip Rega
- Cardiac Surgery Unit, UZ Gasthuisberg Leuven, Leuven, Belgium
| | | | | | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
- Cardiac Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| |
Collapse
|
14
|
Jovanovic MM, Micovic SV, Peric MS, Zivkovic IS, Krasic SD, Milicevic OS, Stankovic SP, Vukovic PM. Low-Risk Surgical Aortic Valve Replacement in the Era of Transcatheter Aortic Valve Implantation. Tex Heart Inst J 2022; 49:477162. [DOI: 10.14503/thij-20-7435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Open surgical aortic valve replacement (SAVR) is a viable alternative to transcatheter implantation in low-risk patients. In this light, we evaluated the safety and effectiveness of SAVR performed through conventional and less invasive surgical approaches in a high-volume center.
We retrospectively reviewed the records of 395 consecutive patients who underwent open SAVR from January 2019 through December 2019 in our center. We evaluated and compared the operative results and postoperative major adverse outcomes of 3 surgical approaches: full median sternotomy (n=267), upper ministernotomy (ministernotomy) (n=106), and right anterior thoracotomy (minithoracotomy) (n=22).
Overall, the 30-day all-cause mortality rate was 0.8% (3 patients). Stroke occurred in 8 patients (2%), disabling stroke in 4 patients (1%), myocardial infarction in 1 (0.2%), and surgical site infection in 13 (3.2%). There was no difference in 30-day mortality rate or incidence of postoperative major adverse events among the 3 surgical groups. Stroke and surgical site infection occurred more frequently, but not significantly so, in the full-sternotomy group. The mean hospital stay was longer after full sternotomy (9.1 ± 5.5 d) than after ministernotomy (7.5 ± 2.9 d) or minithoracotomy (7.4 ± 1.9 d) (P=0.012).
Our findings suggest that open SAVR performed in a high-volume center is associated with a low early mortality rate and that less invasive approaches result in faster postoperative recovery and shorter hospital stays.
Collapse
Affiliation(s)
- Milos M. Jovanovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Slobodan V. Micovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Miodrag S. Peric
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Igor S. Zivkovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Stasa D. Krasic
- Department of Cardiology, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia
| | - Ognjen S. Milicevic
- Department of Medical Statistics and Informatics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan P. Stankovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Petar M. Vukovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| |
Collapse
|
15
|
Dokollari A, Ramlawi B, Torregrossa G, Sá MP, Sicouri S, Prifti E, Gelsomino S, Bonacchi M. Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis. Front Cardiovasc Med 2022; 8:789392. [PMID: 35071358 PMCID: PMC8766961 DOI: 10.3389/fcvm.2021.789392] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/29/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: To highlight the main target points covered by clinical studies on the Perceval sutureless valve for surgical aortic valve replacement (SAVR) and raise a point of discussion for further expansion of its use when compared with stented bioprostheses (SB) and transcatheter aortic valve replacement (TAVR). Methods: We reviewed clinical trials and retrospective studies published up to date and compared the outcomes in terms of mortality, myocardial infarction (MI) stroke, paravalvular leak (PVL), permanent pacemaker implantation (PPI), bleeding and long-term outcomes. Results: Clinical studies showed that 30-day mortality ranged from 0–4% for Perceval and 2.9–7% for TAVR. The incidence of PVL (Perceval 1.9–19.4 vs. TAVR 9–53.5%), PPI (Perceval 2–11.2 vs. TAVR 4.9–25.5%), stroke (Perceval 0 vs. TAVR 0–2.8%), MI (Perceval 0 vs. TAVR 0–3.5%), were all higher in the TAVR group. Compared to other SB, mortality ranged from 0–6.4% for Perceval and 0–5.9% for SB. The incidence of PVR (Perceval 1–19.4 vs. SB 0–1%), PPI (Perceval 2–10.7 vs. SB 1.8–8.5%), stroke (Perceval 0–3.7 vs. SB 1.8–7.3%) and MI (Perceval 0–7.8 vs. SB 0–4.3%) were comparable among the groups. In patients with a bicuspid aortic valve, mortality rate was (0–4%) and PVL incidence was (0–2.3%). However, there was a high incidence of PPI (0–20%), and stroke (0–8%). Long-term survival ranged between 96.7–98.6%. Conclusions: The Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its implantation speed, the reduced cardiopulmonary bypass time, the reduced aortic cross-clamp time and the shorter intensive care unit and hospital length of stay.
Collapse
Affiliation(s)
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Edvin Prifti
- Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Sandro Gelsomino
- Department of Cardiac Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, Netherlands
| | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
16
|
Vilalta V, Alperi A, Cediel G, Mohammadi S, Fernández-Nofrerias E, Kalvrouziotis D, Delarochellière R, Paradis JM, González-Lopera M, Fadeuilhe E, Carrillo X, Abdul-Jawad Altisent O, Rodríguez-Leor O, Voisine P, Bayés-Genís A, Rodés-Cabau J. Midterm Outcomes Following Sutureless and Transcatheter Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. Circ Cardiovasc Interv 2021; 14:e011120. [PMID: 34607449 DOI: 10.1161/circinterventions.121.011120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sutureless-surgical aortic valve replacement (SU-SAVR) has been proposed as a surgical alternative for treating aortic stenosis, which facilitates a minimally invasive approach. While some studies have compared the early outcomes of SU-SAVR versus transcatheter aortic valve replacement (TAVR), most data were obtained in high-risk patients and/or limited to in-hospital outcomes. This study aimed to compare in-hospital and midterm clinical outcomes following SU-SAVR and TAVR in low-risk patients with aortic stenosis. METHODS A total of 806 consecutive low-risk (EuroSCORE II <4%) patients underwent TAVR or SU-SAVR between 2011 and 2020 in 2 centers. A 1:1 propensity score matching was performed and identified 171 pairs with similar characteristics that were included in the analysis. Baseline characteristics, in-hospital and follow-up events (defined according to Valve Academic Research Consortium-2) were collected. RESULTS Baseline characteristics were well balanced between groups, with a median EuroSCORE II of 1.9% (1.3%-2.5%) in both SU-SAVR and TAVR groups (P=0.85). There were no statistically significant differences regarding in-hospital mortality (SU-SAVR: 4.1%, TAVR: 1.8%, P=0.199) and stroke (SU-SAVR: 2.3%, TAVR: 2.9%, P=0.736), but SU-SAVR recipients exhibited higher rates of bleeding and new-onset atrial fibrillation, higher residual transvalvular gradients (P<0.001), and a lower rate of pacemaker implantation (P=0.011). After a median follow-up of 2 (1-3) years, there were no differences between groups in all-cause mortality (hazard ratio, 0.97 [95% CI, 0.52-1.82], P=0.936) and stroke (hazard ratio, 0.83 [95% CI, 0.32-2.15], P=0.708), but SU-SAVR was associated with a higher risk of heart failure hospitalization (hazard ratio, 5.38 [95% CI, 1.88-15.38], P=0.002). CONCLUSIONS In low-risk patients with aortic stenosis, TAVR was associated with improved in-hospital outcomes (except for conduction disturbances) and valve hemodynamics, compared with SU-SAVR. Although similar mortality and stroke rates were observed at 2-year follow-up, the risk of heart failure hospitalization was higher among SU-SAVR patients. These results may contribute to reinforce TAVR over SU-SAVR for the majority of such patients. Graphic Abstract: A graphic abstract is available for this article.
Collapse
Affiliation(s)
- Victoria Vilalta
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,Department of Medicine, Universitat Autònoma de Barcelona, Spain (V.V., A.B.-G.)
| | - Alberto Alperi
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Germán Cediel
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Eduard Fernández-Nofrerias
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Dimitri Kalvrouziotis
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Robert Delarochellière
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Jean-Michel Paradis
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Marta González-Lopera
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Edgar Fadeuilhe
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Xavier Carrillo
- CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Omar Abdul-Jawad Altisent
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Oriol Rodríguez-Leor
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Pierre Voisine
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Antoni Bayés-Genís
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,Department of Medicine, Universitat Autònoma de Barcelona, Spain (V.V., A.B.-G.)
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.).,Hospital Clínic de Barcelona, Spain (J.R.-C.)
| |
Collapse
|
17
|
Moscarelli M, Santarpino G, Athanasiou T, Mastroroberto P, Fattouch K, Nasso G, Speziale G. A pooled analysis of pacemaker implantation after Perceval sutureless aortic valve replacement. Interact Cardiovasc Thorac Surg 2021; 33:501-509. [PMID: 34000013 DOI: 10.1093/icvts/ivab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/15/2021] [Accepted: 03/31/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We performed a literature meta-analysis to estimate the rate of pacemaker implantation after Perceval sutureless aortic valve replacement. METHODS Pertinent articles were identified from the PubMed, Google Scholar, Ovid MEDLINE and Ovid EMBASE databases. Eligible studies reported the de novo incidence of postoperative pacemaker implantation after Perceval valve surgery. Among 394 articles retrieved, 26 studies including 9492 patients met the inclusion criteria. RESULTS The pooled event rate for postoperative pacemaker implantation was 7% [95% confidence interval (CI) 6-9%]; however, significant heterogeneity was observed across studies. In a sub-analysis, there was no difference between the rates of pacemaker implantation calculated from multicentre and registry studies (8 studies, 6845 patients; 7%, 95% CI 5-10%) and single-centre studies (18 studies, 2647 patients; 7%, 95% CI 5-9%; P = 0.75). Implantation rates were similar in high-volume studies (16 studies, 9121 patients; 7%, 95% CI 5-8%) than in low-volume studies (10 studies, 371 patients; pooled rate: 7%, 95% CI 4-14%; P = 0.5). Postoperative pacemaker implantation rates tended to decrease over time. CONCLUSIONS With a pooled event rate of 7%, postoperative pacemaker implantation remains an important limitation of Perceval sutureless valve surgery, although we observed a degree of variability across included studies. The resultant findings provide a useful estimate for physicians and patients and can serve as a benchmark for future comparative studies. PROSPERO REGISTRATION NUMBER CRD42020188397.
Collapse
Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Imperial College, NHLI, Hammersmith Hospital, London, UK
| | - Giuseppe Santarpino
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | | | - Pasquale Mastroroberto
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| |
Collapse
|
18
|
Balmforth D, Dimagli A, Benedetto U, Uppal R. Fifty years of the pericardial valve: Long-term results in the aortic position. J Card Surg 2021; 36:2865-2875. [PMID: 33982282 DOI: 10.1111/jocs.15604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
It is now 50 years since the development of the first pericardial valve in 1971. In this time significant progress has been made in refining valve design aimed at improving the longevity of the prostheses. This article reviews the current literature regarding the longevity of pericardial heart valves in the aortic position. Side by side comparisons of freedom from structural valve degeneration are made for the valves most commonly used in clinical practice today, including stented, stentless, and sutureless valves. Strategies to reduce structural valve degeneration are also discussed including methods of tissue fixation and anti-calcification, ways to minimise mechanical stress on the valve, and the role of patient prosthesis mismatch.
Collapse
Affiliation(s)
| | | | | | - Rakesh Uppal
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| |
Collapse
|
19
|
Abstract
Since their introduction, it has been demonstrated that minimally invasive aortic valve replacement (MIAVR) approaches are safe and effective for the treatment of aortic valve diseases. To date, the main advantage of these approaches is represented by the reduced surgical trauma, with a subsequent reduced complication rate and faster recovery. This makes such approaches an appealing choice also for frail patients [obese, aged, chronic obstructive pulmonary disease (COPD)]. The standardization of the minimally invasive techniques, together with the implementation of preoperative workup and anesthesiological intra- and post-operative care, led to an amelioration of surgical results and reduction of surgical times. Moreover, the improvement of surgical technology and the introduction of new devices such as sutureless and rapid deployment (SURD) valves, has helped the achievement of comparable results to traditional surgery. However, transcatheter technologies are nowadays more and more important in the treatment of aortic valve disease, also in low risk patients. For this reason surgeons should put new efforts for further reducing the surgical trauma in the future, even taking inspiration from other disciplines. In this review, we aim to present a review of literature evidences regarding minimally invasive treatment of aortic diseases, also reflecting our personal experience with MIAVR techniques. This review could represent a tool for a well-structured patient assessment and preoperative planning, in order to safely carrying out an MIAVR procedure with satisfactory outcomes.
Collapse
Affiliation(s)
- Lorenzo Di Bacco
- U.O. Cardiochirurgia Mininvasiva, Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| | - Antonio Miceli
- U.O. Cardiochirurgia Mininvasiva, Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| | - Mattia Glauber
- U.O. Cardiochirurgia Mininvasiva, Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| |
Collapse
|
20
|
Fischlein T, Meuris B, Folliguet T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, Cerutti E, Asch FM, Haverich A. Midterm outcomes with a sutureless aortic bioprosthesis in a prospective multicenter cohort study. J Thorac Cardiovasc Surg 2021; 164:1772-1780.e11. [PMID: 33597099 DOI: 10.1016/j.jtcvs.2020.12.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to report midterm clinical outcomes with a self-expandable sutureless aortic valve. METHODS Between 2010 and 2013, 658 patients at 25 European institutions received the Perceval sutureless valve (LivaNova Plc, London, United Kingdom). Mean follow-up was 3.8 years; late cumulative follow-up was 2325.2 patient-years. RESULTS The mean age of the population was 78.3 ± 5.6 years and 40.0% (n = 263) were 80 years of age or older; mean Society of Thoracic Surgeons-Predicted Risk of Mortality score was 7.2 ± 7.4. Concomitant procedures were performed in 31.5% (n = 207) of patients. Overall duration of cardiopulmonary bypass time was 64.8 ± 25.2 minutes and aortic cross-clamping time was 40.7 ± 18.1 minutes. Thirty-day all-cause mortality was 3.7% (23 patients), with an observed:expected ratio of 0.51. Overall survival was 91.6% at 1 year, 88.5% at 2 years, and 72.7% at 5 years. Peak and mean gradients remained stable during follow-up, and were 17.8 ± 11.3 mm Hg and 9.0 ± 6.3 mm Hg, respectively, at 5 years. Preoperatively, 33.4% of those who received the Perceval valve (n = 210) were in New York Heart Association functional class I or II versus 93.1% (n = 242) at 5 years. CONCLUSIONS This series, representing, to our knowledge, the longest follow-up with sutureless technology in a prospective, multicenter study, shows that aortic replacement using sutureless valves is associated with low mortality and morbidity and good hemodynamic performance.
Collapse
Affiliation(s)
- Theodor Fischlein
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
| | - Bart Meuris
- Cardiac Surgery, UZ Gasthuisberg, Leuven, Belgium
| | - Thierry Folliguet
- Cardiac Surgery and Transplantation, Hôpital Henri Mondor assistance Publique Hôpitaux de Paris, Paris, France
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Herzzentrum Universitaet Leipzig, Klinik fur Herzchirurgie, Leipzig, Germany; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, School of Medicine, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Elisa Cerutti
- Clinical Affairs Department, LivaNova plc, London, United Kingdom
| | - Federico M Asch
- MedStar Health Research Institute, Washington Hospital Center, Washington, DC
| | - Axel Haverich
- Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
21
|
Fischlein T, Folliguet T, Meuris B, Shrestha ML, Roselli EE, McGlothlin A, Kappert U, Pfeiffer S, Corbi P, Lorusso R. Sutureless versus conventional bioprostheses for aortic valve replacement in severe symptomatic aortic valve stenosis. J Thorac Cardiovasc Surg 2020; 161:920-932. [PMID: 33478837 DOI: 10.1016/j.jtcvs.2020.11.162] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Sutureless aortic valves are a novel option for aortic valve replacement. We sought to demonstrate noninferiority of sutureless versus standard bioprostheses in severe symptomatic aortic stenosis. METHODS The Perceval Sutureless Implant Versus Standard-Aortic Valve Replacement is a prospective, randomized, adaptive, open-label trial. Patients were randomized (March 2016 to September 2018) to aortic valve replacement with a sutureless or stented valve using conventional or minimally invasive approach. Primary outcome was freedom from major adverse cerebral and cardiovascular events (composite of all-cause death, myocardial infarction, stroke, or valve reintervention) at 1 year. RESULTS At 47 centers (12 countries), 910 patients were randomized to sutureless (n = 453) or conventional stented (n = 457) valves; mean ages were 75.4 ± 5.6 and 75.0 ± 6.1 years, and 50.1% and 44.9% were female, respectively. Mean ± standard deviation Society of Thoracic Surgeons scores were 2.4 ± 1.7 and 2.1 ± 1.3, and a ministernotomy approach was used in 50.4% and 47.3%, respectively. Concomitant procedures were performed with similar rates in both groups. Noninferiority was demonstrated for major adverse cerebral and cardiovascular events at 1 year, whereas aortic valve hemodynamics improved equally in both groups. Use of sutureless valves significantly reduced surgical times (mean extracorporeal circulation times: 71.0 ± 34.1 minutes vs 87.8 ± 33.9 minutes; mean crossclamp times: 48.5 ± 24.7 vs 65.2 ± 23.6; both P < .0001), but resulted in a higher rate of pacemaker implantation (11.1% vs 3.6% at 1 year). Incidences of perivalvular and central leak were similar. CONCLUSIONS Sutureless valves were noninferior to stented valves with respect to major adverse cerebral and cardiovascular events at 1 year in patients undergoing aortic valve replacement (alone or with coronary artery bypass grafting). This suggests that sutureless valves should be considered as part of a comprehensive valve program.
Collapse
Affiliation(s)
- Theodor Fischlein
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpital Henri Mondor, Université Paris 12, Créteil, Paris, France
| | - Bart Meuris
- UZ Gasthuisberg Leuven, University Hospital, Leuven, Belgium
| | | | - Eric E Roselli
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Utz Kappert
- Herzzentrum Dresden GmbH Universitätsklinik, Dresden, Germany
| | - Steffen Pfeiffer
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Schön Klinik Vogtareuth, Vogtareuth, Germany
| | | | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | | |
Collapse
|
22
|
Ramsaransing K, Hindori V, Kougioumtzoglou A, Kaya A, Verbeek E. Minimally Invasive Sutureless Aortic Valve Replacement With the Perceval S Bioprosthesis Through Ministernotomy: A Single-Center Experience. Cureus 2020; 12:e11212. [PMID: 33269142 PMCID: PMC7707058 DOI: 10.7759/cureus.11212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives Minimally invasive aortic valve replacement has the potential advantage of faster postoperative recovery compared to open procedures. Moreover, aortic valve replacement with a sutureless valve shortens procedure time. The aim of this study is to report early postoperative outcomes and one-year survival of patients undergoing sutureless aortic valve replacement with the Perceval S bioprosthesis (LivaNova, Milan, Italy) through a ministernotomy. Methods A total of 110 patients underwent sutureless aortic valve replacement in our center with the Perceval S bioprosthesis through a ministernotomy between February 2016 and March 2019. Data regarding preoperative and operative details, hospital stay, postoperative outcomes within 30 days after surgery, and one-year mortality were assessed. Results The mean cross-clamping time and extracorporeal circulation time were 54 ± 14 and 78 ± 21 minutes, respectively. No conversion to full median sternotomy was needed perioperatively. In-hospital mortality was 0.9%. Postoperative peak gradient was 13.3 mmHg; no major paravalvular leakage or valve migration occurred postoperatively. Postoperative complications consisted of one (0.9%) patient requiring full sternotomy for bleeding and two (1.8%) patients requiring re-ministernotomy due to acute tamponade. Pacemaker implantation was needed in four (3.6%) patients. Postoperative ischemic stroke rate and new-onset atrial fibrillation were 0.9% (n = 1) and 20% (n = 22), respectively, and one-year survival was 97.3%. Median intensive care unit and hospital stay were one and eight day(s), respectively. Conclusion Minimally invasive sutureless aortic valve replacement with the Perceval S bioprosthesis through a ministernotomy appears to be a safe procedure with good postoperative results and one-year survival. Further follow-up is needed to evaluate long-term outcomes.
Collapse
Affiliation(s)
- Krishan Ramsaransing
- Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis Ziekenhuis (OLVG) Amsterdam, Amsterdam, NLD
| | - Vikash Hindori
- Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis Ziekenhuis (OLVG) Amsterdam, Amsterdam, NLD
| | | | - Abdullah Kaya
- Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, NLD
| | - Eva Verbeek
- Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis Ziekenhuis (OLVG) Amsterdam, Amsterdam, NLD
| |
Collapse
|
23
|
D'Onofrio A, Tessari C, Lorenzoni G, Cibin G, Martinelli G, Alamanni F, Polvani G, Solinas M, Massetti M, Merlo M, Vendramin I, Di Eusanio M, Mignosa C, Mangino D, Russo C, Rinaldi M, Pacini D, Salvador L, Antona C, Maselli D, De Paulis R, Luzi G, Alfieri O, De Filippo CM, Portoghese M, Musumeci F, Colli A, Gregori D, Gerosa G. Minimally Invasive vs Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses. Ann Thorac Surg 2020; 111:1916-1922. [PMID: 33039363 DOI: 10.1016/j.athoracsur.2020.06.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/13/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this multicenter retrospective study was to compare early and midterm clinical and hemodynamic results of aortic valve replacement with rapid-deployment bioprostheses performed through conventional full-sternotomy vs mini-sternotomy. METHODS Data from the Italian multicenter registry of aortic valve replacement with rapid-deployment bioprostheses (INTU-ITA registry) were analyzed. Patients were divided into 2 groups: full sternotomy (FS) and ministernotomy (MS). Primary endpoint was the comparison of early and midterm mortality. Secondary endpoints were: comparison of intraoperative variables, complications, and hemodynamic performance. A propensity score weighting approach was used for data analysis. RESULTS A total of 1057 patients were analyzed: 435 (41.2%) and 622 (58.8%) in group FS and MS, respectively. Thirty-day mortality was 1.6% and 0.6% in FS and MS groups, respectively (P = .074). cardiopulmonary bypass time was 78.5 minutes and 83 minutes in FS and MS groups, respectively (P = .414). In the overall cohort, the incidence of intraoperative complications and of device success was 3.8% (40 patients) and 95.9% (1014 patients), respectively, with no significant differences between groups. Survival at 1, 3, and 5 years was 94.1%, 98.1%, 88.5% and 91.8%, 85.2%, and 84.8% in FS and MS groups, respectively (P = .412). The 2 groups showed similar postoperative gradients (median mean gradient, FS: 10.0 mm Hg, MS: 11.0 mm Hg; P = .170) and also similar incidence of patient-prosthesis mismatch (FS: 7%, MS: 6.4%, P = .647). CONCLUSIONS According to our data, rapid-deployment bioprostheses allow the performance of minimally invasive aortic valve replacement with similar surgical times and similar clinical and hemodynamic outcomes to conventional surgery and should be considered the first choice in these procedures.
Collapse
Affiliation(s)
- Augusto D'Onofrio
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy.
| | - Chiara Tessari
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | - Giulia Lorenzoni
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | - Giorgia Cibin
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | | | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Marco Solinas
- Department of Cardiac Surgery, Ospedale del Cuore "G. Pasquinucci", Massa, Italy
| | - Massimo Massetti
- Department of Cardiac Surgery, Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Maurizio Merlo
- Department of Cardiac Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Igor Vendramin
- Department of Cardiac Surgery, S. Maria della Misericordia Hospital, University of Udine, Udine, Italy
| | | | - Carmelo Mignosa
- Department of Cardiac Surgery, G.B. Morgagni Hospital, Catania, Italy
| | - Domenico Mangino
- Department of Cardiac Surgery, L'Angelo Hospital, Mestre-Venezia, Italy
| | - Claudio Russo
- Department of Cardiac Surgery, Niguarda Hospital, Milan, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, University Hospital of Turin, Turin, Italy
| | - Davide Pacini
- Department of Cardiac Surgery, University Hospital of Bologna, Bologna, Italy
| | - Loris Salvador
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Antona
- Department of Cardiac Surgery, Sacco Hospital, Milan, Italy
| | - Daniele Maselli
- Department of Cardiac Surgery, S. Anna Hospital, Catanzaro, Italy
| | | | - Giampaolo Luzi
- Department of Cardiac Surgery, San Carlo Hospital, Potenza, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Milano, Italy
| | | | - Michele Portoghese
- Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
| | | | - Andrea Colli
- Department of Cardiac Surgery, University Hospital of Pisa, Pisa, Italy
| | - Dario Gregori
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| |
Collapse
|
24
|
Minimally Invasive Aortic Valve Replacement on Minimally Invasive Extracorporeal Circulation: Going beyond Aesthetics. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 52:90-95. [PMID: 32669734 DOI: 10.1182/ject-2000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/14/2020] [Indexed: 11/20/2022]
Abstract
We present our multidisciplinary and multistep strategy in patients undergoing minimally invasive aortic valve replacement (mAVR) on minimally invasive extracorporeal circulation (MiECC) compared with control groups of a single strategy and conventional techniques. This cohort study included high-risk patients (Society of Thoracic Surgeons [STS] risk score >8%) undergoing aortic valve surgery under different strategies during the period from January 2017 until March 2019. Patients were matched for age, gender, body mass index, and STS score: group 1 (MiAVR) based on a minimally invasive technique with J-mini-sternotomy, rapid deployment valve (RDV), and type IV customized MiECC; group 2 (control-mAVR) consisted of minimally invasive technique with only J mini-sternotomy and RDV on a conventional extracorporeal system; group 3 (control-MiECC): full sternotomy and type IV customized MiECC; and group 4 (control): full sternotomy on a conventional extracorporeal system. The MiAVR group had significantly less duration of x-clamp time (35.4 ± 11 minutes), postoperative respiratory support (4.1 ± 1 hour), postoperative hemorrhage (250 ± 50 mL), and intensive care unit stay (1 ± .5 days) than the control-conventional (group 4) group. Seventy-six percent of patients did not receive any blood products in MiAVR (p = .025 vs. group 4). Incidence of atrial fibrillation (8%) and low cardiac output (14%) in MiAVR were significantly better than control. Critics of minimally invasive techniques sustain that potential advantages are offset by a longer cross-clamp and cardiopulmonary bypass duration, which may translate into inferior clinical outcomes. We advocate that our multidisciplinary approach supported by multiple technologies may be associated with faster recovery and superior outcomes than conventional minimally/conventional techniques.
Collapse
|
25
|
Woldendorp K, Doyle MP, Bannon PG, Misfeld M, Yan TD, Santarpino G, Berretta P, Di Eusanio M, Meuris B, Cerillo AG, Stefàno P, Marchionni N, Olive JK, Nguyen TC, Solinas M, Bianchi G. Aortic valve replacement using stented or sutureless/rapid deployment prosthesis via either full-sternotomy or a minimally invasive approach: a network meta-analysis. Ann Cardiothorac Surg 2020; 9:347-363. [PMID: 33102174 DOI: 10.21037/acs-2020-surd-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background New technologies such as sutureless or rapid deployment prosthetic valves and access via minimally invasive incisions offer alternatives to traditional full-sternotomy aortic valve replacement (SAVR). However, a comprehensive comparison of these surgical techniques along with alternative valve prosthesis has not been completed. Methods Electronic databases were searched for studies comparing outcomes for SAVR, minimally invasive AVR (MiAVR), sutureless/rapid-deployment AVR (SuAVR) via full-sternotomy, or minimally invasive SuAVR (MiSuAVR) from their inception until September 2018. Early postoperative outcomes and follow-up data were included in a Bayesian network meta-analysis. Results Twenty-three studies with 8,718 patients were identified. Compared with standard SAVR, SuAVR had significantly lower incidence of postoperative AF [odds ratio (OR) 0.33, 95% confidence interval (CI): 0.14-0.79, P=0.013] and MiSuAVR greater requirement for postoperative permanent pacemaker (OR 2.27, 95% CI: 1.25-4.14, P=0.008). All sutureless/rapid-deployment procedures had reduced cardiopulmonary bypass and cross-clamp times, by a mean of 25.9 and 25.0 min, respectively. Hospital length of stay (LOS), but not intensive care LOS, was reduced for all groups (MiAVR -1.53 days, MiSuAVR -2.79 days, and SuAVR 3.37 days). A signal towards reduced early mortality, wound infections, and acute kidney injury was noted in both sutureless/rapid-deployment and minimally invasive techniques but did not achieve significance. Sutureless/rapid-deployment procedures had favourable survival and freedom from valve related reoperation, however follow-up times were short and demonstrated significant heterogeneity between intervention groups. Conclusions Minimally invasive and sutureless techniques demonstrate equivalent early postoperative outcomes to SAVR and may reduce ventilation time, hospital LOS and postoperative atrial fibrillation (POAF) burden.
Collapse
Affiliation(s)
- Kei Woldendorp
- Sydney Medical School, The University of Sydney, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mathew P Doyle
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Martin Misfeld
- Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Tristan D Yan
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Adventist Hospital, Sydney, Australia
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.,Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Pierluigi Stefàno
- Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy.,University of Florence School of Medicine, Florence, Italy
| | - Niccolò Marchionni
- University of Florence School of Medicine, Florence, Italy.,Unit of Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas, USA.,Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA
| | - Marco Solinas
- Ospedale del Cuore Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Giacomo Bianchi
- Ospedale del Cuore Fondazione Toscana "G. Monasterio", Massa, Italy
| |
Collapse
|
26
|
Williams ML, Flynn CD, Mamo AA, Tian DH, Kappert U, Wilbring M, Folliguet T, Fiore A, Miceli A, D'Onofrio A, Cibin G, Gerosa G, Glauber M, Fischlein T, Pollari F. Long-term outcomes of sutureless and rapid-deployment aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg 2020; 9:265-279. [PMID: 32832408 DOI: 10.21037/acs-2020-surd-25] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Sutureless and rapid-deployment aortic valve replacement (SURD-AVR) has become a prominent area of research as the medical community evaluate its place amongst other aortic valve interventions. The main advantages of SURD-AVR established to date are the reduced cross-clamp and cardiopulmonary bypass (CPB) times, as well as facilitating minimally invasive surgery in high-risk surgical patients. This current systematic review and meta-analysis, to our knowledge, is the first focusing on long-term outcomes regarding safety, efficacy and durability of SURD-AVR from available current literature. Methods A literature search via six electronic databases was performed from their inception to November 2019. Inclusion criteria for this systematic review included survival and postoperative echocardiographic outcomes greater than five years in patients who underwent SURD-AVR with either Perceval or Intuity valves. Studies were identified and data extracted by two independent reviewers. Long-term survival outcomes were aggregated using digitized Kaplan-Meier curves where available. Results After applying predefined inclusion and exclusion criteria, four studies were identified for review. All four studies were observational and in total reported data for 1,998 patients. Almost half (42.4%) of patients underwent SURD-AVR via full sternotomy, with almost one third (30.1%) also undergoing concomitant cardiac procedures. Aggregate overall survival rates at 1-, 2-, 3-, and 5-year follow-up were 94.9%, 91.2%, 89.0%, and 84.2%, respectively. Incidence of strokes (4.8%), severe paravalvular leaks (PVLs) (1.5%) and permanent pacemaker (PPM) insertion (8.2%) at up to 5-year follow-up were acceptable. At 5-year follow-up hemodynamic outcomes were also acceptable for mean pressure gradient (MPG) (range, 8.8-13.6 mmHg), peak pressure gradient (PPG) (range, 18.9-21.1 mmHg) and effective orifice area (EOA) (range, 1.5-1.8 cm2). Conclusions Evaluation of the evidence reporting long-term outcomes of SURD-AVR suggests that it is a safe procedure for AVR with low rates of complications. Long-term outcomes presented in this review show that not only does SURD-AVR have acceptable survival rates, but also good hemodynamic performance at 5-year follow-up.
Collapse
Affiliation(s)
- Michael L Williams
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Campbell D Flynn
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Melbourne, Australia
| | - Andrew A Mamo
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Thierry Folliguet
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Antonio Miceli
- Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | | | - Giorgia Cibin
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio - Gruppo San Donato, Milano, Italy
| | - Theodor Fischlein
- Cardiac Surgery, Paracelsus Medical University - Klinikum Nürnberg, Nuremberg, Germany
| | - Francesco Pollari
- Cardiac Surgery, Paracelsus Medical University - Klinikum Nürnberg, Nuremberg, Germany
| |
Collapse
|
27
|
Fatehi Hassanabad A, El Idrissi KR, Kent WDT. Right anterior minithoracotomy approach for resection of papillary fibroelastoma. J Card Surg 2020; 35:1729-1731. [PMID: 32485064 DOI: 10.1111/jocs.14674] [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: 11/30/2022]
Abstract
BACKGROUND Right anterior minithoracotomy (RAMT) is an alternative to full or partial sternotomy for accessing the aortic valve. The adoption of this approach for aortic valve replacement has been limited by its perceived technical complexity. Resection of a mobile aortic valve tumor is a simple procedure that is conventionally done through a sternotomy. AIM The following case describes the resection of an aortic valve papillary fibroelastoma through an RAMT. MATERIALS & METHODS This is a report on a single patient's case. RESULTS The fibroelastoma was safely excised through a RAMT approach. DISCUSSION An aortic valve fibroelastoma offers an ideal starting point for surgeons to begin using a RAMT approach. CONCLUSION The excision of aortic valve masses is a procedure that is well suited to minimally invasive strategies, and we suggest sternum-sparing RAMT is the optimal approach.
Collapse
Affiliation(s)
- Ali Fatehi Hassanabad
- Division of Cardiac Surgery, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Canada
| | - Kenza R El Idrissi
- Undergraduate Medical Education, Faculty of Medicine, McGill University, Montreal, Canada
| | - William D T Kent
- Division of Cardiac Surgery, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Canada
| |
Collapse
|