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Spadaccio C, Nenna A, Pisani A, Laskawski G, Nappi F, Moon MR, Biancari F, Jassar AS, Greason KL, Shrestha ML, Bonaros N, Rose D. Sutureless Valves, a "Wireless" Option for Patients With Aortic Valve Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:382-407. [PMID: 39019533 DOI: 10.1016/j.jacc.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 07/19/2024]
Abstract
Transcatheter technologies triggered the recent revision of the guidelines that progressively widened the indications for the treatment of aortic stenosis. On the surgical realm, a technology avoiding the need for sutures to anchor the prosthesis to the aortic annulus has been developed with the aim to reduce the duration of cardiopulmonary bypass and simplify the process of valve implantation. In addition to a transcatheter aortic valve replacement (TAVR)-like stent that exerts a radial force, these so-called "rapid deployment valves" or "sutureless valves" for aortic valve replacement also have cuffs to improve sealing and reduce the risk of paravalvular leak. Despite promising, the actual advantage of sutureless valves over traditional surgical procedures (surgical aortic valve replacement) or TAVR is still debated. This review summarizes the current comparative evidence reporting outcomes of "sutureless valves" for aortic valve replacement to TAVR and surgical aortic valve replacement in the treatment of aortic valve stenosis.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom; Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Antonio Nenna
- Cardiovascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Angelo Pisani
- Cardiac Surgery, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Grzegorz Laskawski
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Marc R Moon
- Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, Texas, USA
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital/University of Helsinki, Helsinki, Finland
| | - Arminder S Jassar
- Cardiac Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - Kevin L Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Malakh L Shrestha
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA; Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany
| | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - David Rose
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
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Im JE, Jung EY, Lee SS, Min HK. Right anterior mini-thoracotomy aortic valve replacement versus transcatheter aortic valve implantation in octogenarians: a single-center retrospective study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:96-102. [PMID: 38404057 DOI: 10.12701/jyms.2023.01228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The aim of this study was to compare the early outcomes of octogenarians undergoing minimally invasive right anterior mini-thoracotomy aortic valve replacement (RAT-AVR) with those undergoing transcatheter aortic valve implantation (TAVI) for aortic valve disease. METHODS In this single-center retrospective study, data were collected from octogenarians before and after RAT-AVR and TAVI between January 2021 and July 2022. Short-term outcomes, including the length of hospital stay, in-hospital mortality, all-cause mortality, and other major postoperative complications, were compared and analyzed. RESULTS There were no significant differences in in-hospital mortality, stroke, acute kidney dysfunction requiring renal replacement therapy, length of intensive care unit stay, or length of hospital stay. However, the TAVI group had a higher incidence of permanent pacemaker insertion (10% vs. 0%, p=0.54) and paravalvular leaks (75% vs. 0%, p<0.001). CONCLUSION In the present study on octogenarians, both TAVI and RAT-AVR showed comparable short-term results. Although both procedures were considered safe and effective in the selected group, RAT-AVR had a lower incidence of complete atrioventricular block and paravalvular regurgitation.
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Affiliation(s)
- Ji Eun Im
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Yeung Jung
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Seok Soo Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Ho-Ki Min
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
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Eghbalzadeh K, Kuhn EW, Gerfer S, Djordjevic I, Rahmanian P, Mader N, Wahlers TCW. Ten-Year Long-Term Analysis of Mechanical and Biological Aortic Valve Replacement. Thorac Cardiovasc Surg 2024; 72:167-172. [PMID: 35667381 DOI: 10.1055/s-0042-1744477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND For patients undergoing aortic valve replacement (AVR), structural valve deterioration (SVD) of a bioprosthesis (BP) is substantially accelerated in younger patients and valve-in-valve implantation is not always a considerable option. The risk-benefit assessment between SVD versus the risk of bleeding and thromboembolic events in patients with a mechanical prosthesis (MP) resulted in an age limit shift irrespective of inconsistent results reported in literature. METHOD This retrospective single-center study compared 10-year long-term outcomes in patients undergoing isolated AVR with MP or BP. The risk-adjusted comparison of patients undergoing isolated AVR (n = 121) was performed after 1:1 propensity score matching (PSM) for age, sex, endocarditis, and chronic renal impairment (caliper of 0.2) leading to 29 pairs. Short- and long-term outcomes with respect to reoperation, major bleeding, stroke, all-cause and cardiovascular mortality, and overall survival at 10 years were analyzed. RESULTS After PSM, groups were comparable with respect to preoperative characteristics, including patients with a mean age of 65 ± 3 years (MP) and 66 ± 4 years (BP) and an incidence rate of 6.9% for infective endocarditis in both cohorts. Short-term outcomes (transient neurologic disorder = 0.0 vs. 6.9%; stroke = 0.0%; in-hospital mortality = 3.4%) and in-hospital stays were comparable between MP and BP. CONCLUSION After isolated AVR with MP and BP, 10-year long-term outcomes were comparable in the reported single-center cohort. MP can still be implanted safely without a disadvantage as regards long-term survival.
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Affiliation(s)
- Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
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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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Juarez-Casso FM, Crestanello JA. The Evolving Role of Surgical Aortic Valve Replacement in the Era of Transcatheter Valvular Procedures. J Clin Med 2023; 12:5299. [PMID: 37629341 PMCID: PMC10455383 DOI: 10.3390/jcm12165299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Surgical aortic valve replacement (SAVR) has long been the standard treatment for severe symptomatic aortic stenosis (AS). However, transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative; it was initially intended for high-risk patients and has now expanded its use to patients of all risk groups. While TAVR has demonstrated promising outcomes in diverse patient populations, uncertainties persist regarding its long-term durability and potential complications, raising the issue of the ideal lifetime management strategy for patients with AS. Therefore, SAVR continues to play an important role in clinical practice, particularly in younger patients with longer life expectancies, those with complex aortic anatomy who are unsuitable for TAVR, and those requiring concomitant surgical procedures. The choice between TAVR and SAVR warrants personalized decision-making, considering patient characteristics, comorbidities, anatomical considerations, and overall life expectancy. A multidisciplinary approach involving an experienced heart team is crucial in the preoperative evaluation process. In this review, we aimed to explore the current role of surgical management in addressing aortic valve stenosis amidst the expanding utilization of less invasive transcatheter procedures.
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Affiliation(s)
| | - Juan A. Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA;
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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.
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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
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Jolliffe J, Moten S, Tripathy A, Skillington P, Tatoulis J, Muneretto C, Di Bacco L, Galvao HBF, Goldblatt J. Perceval valve intermediate outcomes: a systematic review and meta-analysis at 5-year follow-up. J Cardiothorac Surg 2023; 18:129. [PMID: 37041628 PMCID: PMC10091543 DOI: 10.1186/s13019-023-02273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES New technologies for the treatment of Aortic Stenosis are evolving to minimize risk and treat an increasingly comorbid population. The Sutureless Perceval Valve is one such alternative. Whilst short-term data is promising, limited mid-term outcomes exist, until now. This is the first systematic review and meta-analysis to evaluate mid-term outcomes in the Perceval Valve in isolation. METHODS A systematic literature review of 5 databases was performed. Articles included evaluated echocardiographic and mortality outcomes beyond 5 years in patients who had undergone Perceval Valve AVR. Two reviewers extracted and reviewed the articles. Weighted estimates were performed for all post-operative and mid-term data. Aggregated Kaplan Meier curves were reconstructed from digitised images to evaluate long-term survival. RESULTS Seven observational studies were identified, with a total number of 3196 patients analysed. 30-day mortality was 2.5%. Aggregated survival at 1, 2, 3, 4 and 5 years was 93.4%, 89.4%, 84.9%, 82% and 79.5% respectively. Permanent pacemaker implantation (7.9%), severe paravalvular leak (1.6%), structural valve deterioration (1.5%), stroke (4.4%), endocarditis (1.6%) and valve explant (2.3%) were acceptable at up to mid-term follow up. Haemodynamics were also acceptable at up mid-term with mean-valve gradient (range 9-13.6 mmHg), peak-valve gradient (17.8-22.3 mmHg) and effective orifice area (1.5-1.8 cm2) across all valve sizes. Cardiopulmonary bypass (78 min) and Aortic cross clamp times (52 min) were also favourable. CONCLUSION To our knowledge, this represents the first meta-analysis to date evaluating mid-term outcomes in the Perceval Valve in isolation and demonstrates good 5-year mortality, haemodynamic and morbidity outcomes. KEY QUESTION What are the mid-term outcomes at up to 5 years follow up in Perceval Valve Aortic Valve Replacement? KEY FINDINGS Perceval Valve AVR achieves 80% freedom from mortality at 5 years with low valve gradients and minimal morbidity. KEY OUTCOMES Perceval Valve Aortic Valve Replacement has acceptable mid-term mortality, durability and haemodynamic outcomes.
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Affiliation(s)
- Jarrod Jolliffe
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia.
| | - Simon Moten
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Amit Tripathy
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Peter Skillington
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - James Tatoulis
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | | | - Lorenzo Di Bacco
- School of Cardiac Surgery, University of Brescia, Brescia, Italy
| | | | - John Goldblatt
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
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Zubarevich A, Szczechowicz M, Arjomandi Rad A, Amanov L, Ruhparwar A, Weymann A. Conventional Biological versus Sutureless Aortic Valve Prostheses in Combined Aortic and Mitral Valve Replacement. Life (Basel) 2023; 13:life13030737. [PMID: 36983892 PMCID: PMC10056806 DOI: 10.3390/life13030737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/03/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Sutureless aortic valve prostheses have proven to provide a significant decrease in procedural, cardiopulmonary bypass and cross-clamp time, leading to a significant reduction in mortality risk in elderly high-risk cohorts. In this study, we sought to review our institutional experience on the sutureless aortic valve replacement (SU-AVR) and the concomitant mitral valve replacement (SMVR), comparing the combined conventional surgical aortic valve replacement (SAVR) with SMVR. METHODS AND MATERIAL Between March 2018 and July 2022, 114 consecutive patients underwent a combined aortic and mitral valve replacement at our institution. We stratified the patients according to the operative procedures into two groups and matched them 1:2: Group 1 underwent a combined conventional SAVR and SMVR (n = 46), and Group 2 included combined SU-AVR with Perceval prosthesis and SMVR (n = 23). RESULTS No significant differences in the preoperative characteristics were present. SU-AVR combined with SMVR demonstrated excellent haemodynamic performance, comparable to that of SAVR plus SMVR, with median postoperative gradients over the aortic valve of 4 mmHg (IQR 3.0-4.0) in Group 1 and 4 mmHg (IQR 3.0-4.0) in Group 2 (p = 0.67). There was no significant difference in the occurrence of postoperative major adverse events such as death, stroke, myocardial infarction and kidney failure between the groups. There was also no significant difference in the permanent pacemaker implantation rate, paravalvular leakage or valve dislocation. We also could not detect any significant difference in postoperative mortality between the groups. CONCLUSIONS SU-AVR has proven to be a reliable alternative to conventional valve prostheses in patients with multivalve disease undergoing combined aortic and mitral valve replacement, offering shorter procedural time and outstanding hemodynamic performance compared to the conventional surgical method.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, 45147 Essen, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, 45147 Essen, Germany
| | | | - Lukman Amanov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, 45147 Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, 45147 Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, 45147 Essen, Germany
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Mechulan A, Demoulin R, Dieuzaide P, Peret A, Vaillant A, Vicat J, Bouharaoua A, Leude-Vaillant E, Cornen A, Prevot S. Early pacemaker insertion after aortic valve replacement with an Edwards Intuity sutureless valve. Arch Cardiovasc Dis 2022; 115:490-495. [PMID: 36127272 DOI: 10.1016/j.acvd.2022.05.007] [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: 11/30/2021] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Postoperative conduction disorders are serious adverse events in patients undergoing aortic valve replacement, and may prolong the duration of hospitalization and require pacemaker insertion. AIM Our aim was to evaluate the rate of pacemaker insertion after implantation of an Edwards Intuity sutureless aortic valve (Edwards Lifesciences, Irvine, CA, USA) compared with a standard surgical bioprosthesis. METHODS This retrospective single-centre study included patients who underwent aortic valve replacement with an Intuity sutureless aortic valve or a standard bioprosthetic valve between 4 June 2014 and 27 June 2016. The main outcome criterion was the rate of postoperative pacemaker insertion. Secondary outcome criteria included the rate of new conduction disorders, the rate of atrial arrhythmia or paroxysmal conduction disorders, mortality and duration of hospital stay. RESULTS Ninety-three patients received an Intuity sutureless aortic valve (median age 76 years, interquartile range 71-80 years), and 176 were implanted with a standard biological aortic valve (median age 73 years, interquartile range 68-79 years; P=0.007). The rate of postoperative pacemaker insertion, after adjustment, was 22.44% in the Intuity group and 5.66% in the standard aortic valve group (P=0.030). The main indications for postoperative pacemaker insertion were complete atrioventricular block and left bundle branch block with prolongation of the H-V interval. The rate of new postoperative left bundle branch block conduction disorders was significantly higher in patients implanted with an Intuity valve (odds ratio 5.28, 95% confidence interval 1.59 to 23.05; P=0.012). CONCLUSION Higher rates of pacemaker insertion and new conduction disorders were observed in patients implanted with an Intuity sutureless bioprosthesis compared with those who received a standard surgical aortic valve.
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Affiliation(s)
- Alexis Mechulan
- Service de cardiologie, Ramsay Santé, hôpital privé Clairval, 13009 Marseille, France.
| | - Raphaël Demoulin
- Service de cardiologie, hôpital d'instruction des armées Sainte-Anne, 83800 Toulon, France
| | - Pierre Dieuzaide
- Service de cardiologie, Ramsay Santé, hôpital privé Clairval, 13009 Marseille, France
| | - Angélique Peret
- Service de cardiologie, Ramsay Santé, hôpital privé Clairval, 13009 Marseille, France
| | - Alain Vaillant
- Service de chirurgie cardiaque, Ramsay Santé, hôpital privé Clairval, 13009 Marseille, France
| | - Jacques Vicat
- Service de chirurgie cardiaque, Ramsay Santé, hôpital privé Clairval, 13009 Marseille, France
| | - Ahmed Bouharaoua
- Service de cardiologie, Ramsay Santé, hôpital privé Clairval, 13009 Marseille, France
| | | | - Alain Cornen
- Service de chirurgie cardiaque, Ramsay Santé, hôpital privé Clairval, 13009 Marseille, France
| | - Sébastien Prevot
- Service de cardiologie, Ramsay Santé, hôpital privé Clairval, 13009 Marseille, France
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Iacovelli F, Desario P, Cafaro A, Pignatelli A, Alemanni R, Montesanti R, Bortone AS, De Cillis E, De Palo M, Bardi L, Martinelli GL, Tesorio T, Cassese M, Contegiacomo G. The hemodynamic performance of balloon-expandable aortic bioprostheses in the elderly: a comparison between rapid deployment and transcatheter implantation. Hellenic J Cardiol 2022; 68:9-16. [PMID: 35863727 DOI: 10.1016/j.hjc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical aortic valve replacement with a rapid deployment valve (RDV) is a relatively recent treatment option. Aim of this study was to compare the hemodynamic performance of balloon-expandable (BE)-RDVs and BE-transcatheter heart valves (THVs) in a high surgical risk and frail-elderly population. METHODS BE-THVs and BE-RDVs were respectively implanted in 138 and 47 patients, all older than 75 years and with a Canadian Study of Health and Aging category of 5 or above. Echocardiographic assessment was performed at discharge and at six months. RESULTS At discharge, transprosthetic pressure gradients and indexed effective orifice area (iEOA) were similar in both cohorts. At six-month follow-up, BE-RDV showed lower peak (14.69 vs 20.86 mmHg; p <0.001) and mean (7.82 vs 11.83 mmHg; p <0.001) gradients, as well as larger iEOA (1.05 vs 0.84 cm2/m2; p <0.001). Similar findings were also shown considering only small sized valves. Moderate-to-severe paravalvular leakage was more prevalent in BE-THVs at discharge (14.49 vs 0.00%; p=0.032) and, considering exclusively small prostheses, at six months too (57.69 vs 15.00%; p=0.014). Nevertheless, BE-THVs determined amelioration in left ventricular ejection fraction (53.79 vs 60.14%; p <0.001), pulmonary artery systolic pressure (35.81 vs 33.15 mmHg; p=0.042) and tricuspid regurgitation severity (40.58 vs 19.57%; p=0.031) from discharge to mid-term follow-up. CONCLUSIONS BE-RDVs showed better hemodynamic performance, especially when implanted in small annulus. Despite their worse baseline conditions, transcatheter patients still exhibited a greater improvement of their echocardiographic profile at mid-term follow-up.
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Affiliation(s)
- Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy; Division of Cardiology, "SS. Annunziata" Hospital, Via Francesco Bruno 1, 74121 Taranto, Italy.
| | - Paolo Desario
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Alessandro Cafaro
- Division of Cardiology, "V. Fazzi" Hospital, Piazza Filippo Muratore, 73100 Lecce, Italy.
| | - Antonio Pignatelli
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Via Camillo Rosalba 35/37, 70124 Bari, Italy.
| | - Rossella Alemanni
- Division of Heart Surgery, Emergency and Critical Care Department, "Casa Sollievo della Sofferenza" Research Hospital, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.
| | - Rosamaria Montesanti
- Division of Heart Surgery, Emergency and Critical Care Department, "Casa Sollievo della Sofferenza" Research Hospital, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Micaela De Palo
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Luca Bardi
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy.
| | - Gian Luca Martinelli
- Division of Heart Surgery, Cardiovascular Department, "MultiMedica" Research Hospital, Via Milanese 300, 20099 Sesto San Giovanni, Italy.
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, Via Mario Malzoni, 83013 Mercogliano, Italy.
| | - Mauro Cassese
- Division of Heart Surgery, Emergency and Critical Care Department, "Casa Sollievo della Sofferenza" Research Hospital, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.
| | - Gaetano Contegiacomo
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Via Camillo Rosalba 35/37, 70124 Bari, Italy.
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11
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Sá MP, Jabagi H, Dokollari A, Awad AK, Van den Eynde J, Malin JH, Sicouri S, Torregrossa G, Ruhparwar A, Weymann A, Ramlawi B. Early and late outcomes of surgical aortic valve replacement with sutureless and rapid-deployment valves versus transcatheter aortic valve implantation: Meta-analysis with reconstructed time-to-event data of matched studies. Catheter Cardiovasc Interv 2022; 99:1886-1896. [PMID: 35312216 DOI: 10.1002/ccd.30162] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 02/26/2022] [Accepted: 03/09/2022] [Indexed: 11/07/2022]
Abstract
Sutureless/rapid-deployment (SURD) valves are options different from the stented prostheses included in the pivotal trials comparing surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI). We performed a meta-analysis with reconstructed time-to-event data of matched studies published by November 2021 to compare SURD-AVR and TAVI. Primary endpoints were 30-day mortality and overall survival in the follow-up. Secondary endpoints included: 30-day stroke, acute kidney injury (AKI), major bleeding, permanent pacemaker implantation (PPI), paravalvular leak (PVL), prosthesis-patient mismatch (PPM), postoperative aortic valve area (AVA), and mean gradients. Ten studies met our eligibility criteria, including a total of 5134 patients (2567 underwent SURD-AVR and 2567 underwent TAVI). Pooled risk of 30-day mortality did not favor any group (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.31-1.53; p = 0.360). Patients undergoing SURD-AVR had lower risk of PVL (OR: 0.09; 95% CI: 0.05-0.17; p < 0.001). No statistically significant differences were observed for 30-day stroke, AKI, major bleeding, PPI, PPM, and postoperative AVA. In the follow-up, we observed a higher risk of mortality (hazard ratio: 1.74; 95% CI: 1.26-2.40; p < 0.001) with TAVI. Patients who underwent SURD-AVR experienced better survival, however, the interpretation of these results warrant caution due to the fact that SURD-AVR patients tended to be younger than TAVI patients. Structural heart surgeons and interventional cardiologists should consider initial risk and life expectancy when referring patients for one approach over the other.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Habib Jabagi
- Department of Cardiothoracic Surgery, Valley Heart and Vascular Institute, Ridgewood, New Jersey, USA
| | - Aleksander Dokollari
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - John H Malin
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
- Philadelphia College of Osteopathic Medicine, Bala Cynwyd, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
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12
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Kim KS, Makhdoum A, Koziarz A, Gupta S, Alsagheir A, Pandey A, Reza S, Um K, Teoh K, Alhazzani W, Lamy A, Yanagawa B, Belley-Côté EP, Whitlock RP. Outcomes of sutureless aortic valve replacement versus conventional aortic valve replacement and transcatheter aortic valve replacement, updated systematic review, and meta-analysis. J Card Surg 2021; 36:4734-4742. [PMID: 34617322 DOI: 10.1111/jocs.16044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/26/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SuAVR) is an alternative to surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study compares the effectiveness of SuAVR to SAVR and TAVR. METHODS We searched MEDLINE and EMBASE from inception to July 2021 for studies evaluating SuAVR, SAVR, and TAVR in adults with aortic stenosis. We performed screening, full-text assessment, data collection, and risk of bias evaluation independently and in duplicate. We evaluated risk of bias using by Cochrane and CLARITY's tools, and certainty in evidence using the GRADE framework. Data were pooled using a random-effects model. RESULTS We identified one randomized and 78 observational studies (n = 60,689; SuAVR vs. SAVR = 39,171, vs. TAVR = 21,518). All studies were at high or unclear risk of bias, with very-low certainty in effect estimates. Compared to TAVR, SuAVR demonstrates no significant difference in mortality at 30-days (odds ratio [OR]: 0.52, 95% confidence interval [CI: 0.85, 1.16], I2 = 0%), but decreased odds at 2-years (OR: 0.39, 95% CI [0.17, 0.88], I2 = 0%). SuAVR also reduced odds of mild paravalvular regurgitation (OR: 0.11, 95% CI [0.06, 0.21], I2 = 50%). Compared to SAVR, SuAVR was associated with a similar mortality at 30-days (OR: 0.99, 95% CI [0.85, 1.16], I2 = 0%) and 2-years (OR: 0.99, 95% CI [0.43-2.30], I2 = 7%). SuAVR significantly increased odds of permanent pacemaker implantation (OR: 2.5, 95% CI [2.25, 2.77], I2 = 0%). Pooled effect estimates were consistent with results from the randomized trial comparing SuAVR and SAVR. CONCLUSION Based on very-low quality evidence, SuAVR is associated with similar short- and midterm outcomes compared to TAVR and SAVR. Comparative randomized data with long-term follow-up are required to clarify the role of SuAVR.
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Affiliation(s)
- Kevin S Kim
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Ahmad Makhdoum
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Alex Koziarz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ali Alsagheir
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arjun Pandey
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Seleman Reza
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Kevin Um
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Teoh
- Southlake Regional Health Sciences Centre, Newmarket, Ontario, Canada
| | - Waleed Alhazzani
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - André Lamy
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Emilie P Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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13
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Chung YH, Lee SH, Ko YG, Lee S, Shim CY, Ahn CM, Hong GR, Shim JK, Kwak YL, Hong MK. Transcatheter Aortic Valve Replacement versus Sutureless Aortic Valve Replacement: A Single Center Retrospective Cohort Study. Yonsei Med J 2021; 62:885-894. [PMID: 34558867 PMCID: PMC8470564 DOI: 10.3349/ymj.2021.62.10.885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR). MATERIALS AND METHODS In total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared. RESULTS Device success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9±1.6 days vs. 5.9±9.2 days, p=0.009) and hospital (7.1±7.9 days vs. 13.1±8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960). CONCLUSION TAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.
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Affiliation(s)
- Young Hak Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi-Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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14
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Doyle MP, Woldendorp K, Ng M, Vallely MP, Wilson MK, Yan TD, Bannon PG. Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies. J Thorac Dis 2021; 13:1671-1683. [PMID: 33841958 PMCID: PMC8024828 DOI: 10.21037/jtd-20-2233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Minimally invasive aortic valve replacement (MiAVR) and transcatheter aortic valve implantation (TAVI) provide aortic valve replacement (AVR) by less invasive methods than conventional surgical AVR, by avoiding complete sternotomy. This study directly compares and analyses the available evidence for early outcomes between these two AVR methods. Methods Electronic databases were searched from inception until August 2019 for studies comparing MiAVR to TAVI, according to predefined search criteria. Propensity-matched studies with sufficient data were included in a meta-analysis. Results Eight studies with 9,744 patients were included in the quantitative analysis. Analysis of risk-matched patients showed no difference in early mortality (RR 0.76, 95% CI, 0.37–1.54, P=0.44). MiAVR had a signal towards lower rate of postoperative stroke, although this did not reach statistical significance (OR 0.42, 95% CI, 0.13–1.29, P=0.13). MiAVR had significantly lower rates of new pacemaker (PPM) requirement (OR 0.29, 95% CI, 0.16–0.52, P<0.0001) and postoperative aortic insufficiency (AI) or paravalvular leak (PVL) (OR 0.05, 95% CI, 0.01–0.20, P<0.0001) compared to TAVI, (OR 0.42, 95% CI, 0.13–1.29, P=0.13), while acute kidney injury (AKI) was higher in MiAVR compared to TAVI (11.1% vs. 5.2%, OR 2.28, 95% CI, 1.25–4.16, P=0.007). Conclusions In patients of equivalent surgical risk scores, MiAVR may be performed with lower rates of postoperative PPM requirement and AI/PVL, higher rates of AKI and no statistical difference in postoperative stroke or short-term mortality, compared to TAVI. Further prospective trials are needed to validate these results.
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Affiliation(s)
- Mathew P Doyle
- The Royal Prince Alfred Hospital, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,University of Wollongong School of Medicine, Keiraville, Australia
| | - Kei Woldendorp
- The Royal Prince Alfred Hospital, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,The University of Sydney Medical School, Camperdown, Australia
| | - Martin Ng
- The Royal Prince Alfred Hospital, Sydney, Australia.,The University of Sydney Medical School, Camperdown, Australia
| | | | - Michael K Wilson
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - Tristan D Yan
- The Royal Prince Alfred Hospital, Sydney, Australia.,Macquarie University Hospital, Macquarie University, Sydney, Australia.,Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Paul G Bannon
- The Royal Prince Alfred Hospital, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,The University of Sydney Medical School, Camperdown, Australia
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15
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White A, Bozso SJ, Lakey O, Hong Y, Wang S, Nagendran J, Moon MC. Rapid deployment valves versus conventional tissue valves for aortic valve replacement. J Thorac Cardiovasc Surg 2020; 163:2036-2042. [PMID: 32747118 DOI: 10.1016/j.jtcvs.2020.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/25/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Rapid deployment valves have been developed as a means to adjust for limitations in transcatheter aortic valve replacement and surgical aortic valve replacement for the management of aortic valve disease. To date, many studies have shown that although rapid deployment valves facilitate a shorter surgical aortic valve replacement, they offer no clinical benefit. The purpose of this study was to compare the outcomes of rapid deployment valves with conventional surgical aortic valve replacement. METHODS This study was a retrospective review of all patients undergoing tissue aortic valve replacement at a single center. The majority of patients were men and aged more than 60 years. Patients were categorized into 2 groups: (1) rapid deployment valves and (2) conventional sutured valve. Inverse probability treatment weighting method was used to create a cohort of patients with similar baseline characteristics. Kaplan-Meier curves and log-rank tests were used to determine if there were statistically significant differences in outcomes. Primary outcome was all-cause mortality at 30 days, 1 year, and 5 years. RESULTS A total of 2237 patients made up the study population from 2013 to 2019. After inverse probability treatment weighting, there were 295 patients in each group. Shorter cardiopulmonary bypass and crossclamp times were found with the rapid deployment valves. No statistically significant difference was found in the primary and secondary outcomes. There was a significant difference in the rate of permanent pacemaker insertion with a 7% pacemaker rate in the rapid deployment valve group (P < .009). CONCLUSIONS The data suggest that rapid deployment valves offer no benefit in straightforward aortic valve replacement, and further study will help identify which patient population the valve is suited for.
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Affiliation(s)
- Abigail White
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Sabin J Bozso
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Olivia Lakey
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yongzhe Hong
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Shaohua Wang
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Michael C Moon
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
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16
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Zhan Y, Saadat S, Soin A, Kawabori M, Chen FY. A meta-analysis comparing transaxillary and transfemoral transcatheter aortic valve replacement. J Thorac Dis 2019; 11:5140-5151. [PMID: 32030231 DOI: 10.21037/jtd.2019.12.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background While transfemoral (TF) approach is considered as the default access for transcatheter aortic valve replacement (TAVR), the alternative access route of choice remains to be elucidated. Transaxillary (TAx) approach has shown promise as an excellent option. We performed a meta-analysis of the studies comparing the TF and TAx approaches using one type of self-expandable transcatheter valve to avoid device-related bias. Methods We searched PubMed/MEDLINE, EMBASE, and the Cochrane Library from inception to December 2018 to identify articles comparing TAx-TAVR and TF-TAVR. The studies included in this meta-analysis contain data related to the use of the CoreValve device. Patients' baseline characteristics, procedural outcomes, and clinical outcomes were extracted from the articles and pooled for analysis. Results The meta-analysis included five studies comprising 1,414 patients in the TF group and 489 patients in the TAx group. The average EuroScores of the TF and TAx groups were 20.04±13.89 and 22.73±14.73, respectively. The TAx group has higher rates of major comorbidities. No difference was found between the two groups with regard to vascular complications (P=0.71; OR 1.08; 95% CI, 0.71-1.65), aortic regurgitation (P=0.90; OR 1.03; 95% CI, 0.71-1.49), and permanent pacemaker (PPM) implantation (P=0.42; OR 1.12; 95% CI, 0.86-1.46). The TAx group has a lower incidence of acute kidney injury (AKI) (P=0.05; OR 1.63; 95% CI, 1.01-2.62). No difference was observed in 30-day mortality (P=0.32; OR 1.30; 95% CI, 0.78-2.17) or 1-year mortality (P=0.21; OR 0.76; 95% CI, 0.50-1.16). Conclusions TAx-TAVR is associated with overall comparable outcomes to TF TAVR in high-risk patient cohorts, despite higher incidences of major comorbidities in the TAx-TAVR patient population. The rate of AKI appears to be lower after TAx-TAVR.
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Affiliation(s)
- Yong Zhan
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Siavash Saadat
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Avneet Soin
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Masashi Kawabori
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Frederick Y Chen
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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17
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González Barbeito M, Estévez-Cid F, Pardo Martínez P, Velasco García de Sierra C, Iglesias Gil C, Quiñones Laguillo C, Cuenca Castillo JJ. Surgical technique modifies the postoperative atrioventricular block rate in sutureless prostheses. J Thorac Dis 2019; 11:2945-2954. [PMID: 31463124 DOI: 10.21037/jtd.2019.07.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The main objective was to analyse the impact of the modification of the Perceval S implantation technique on the prevalence of postoperative atrioventricular block, which requires a permanent pacemaker, in our aortic valve replacement series. In addition, we attempted to identify those risk factors that are related to the appearance of this complication. Methods Five hundred and seventy-two valve replacements were carried out with PERCEVAL S in our centre up to July 2018. Use of modified technique (n=302). Minimally invasive approach (n=340). Associated coronary surgery (n=95). Patients with pacemakers prior to surgery (n=27) and associated mitral or tricuspid valve surgery (n=26) were excluded. We analysed variables of interest that could influence the increase in postoperative atrioventricular block. Technique performed, disorders of intraventricular conduction and pre/intraoperative characteristics. The influence of the modified technique was analysed. Results Five hundred and nineteen aortic valve replacements with PERCEVAL S. Age (years) (median 77, interquartile range 8). Height (cm) (159, 13.5). Euroscore II (%) (2.25, 2.27). Postoperative atrioventricular block standard technique (n=23, 10.14%). Modified technique (n=14, 4.30%) (P=0.009). Multivariate regression analysis. Final model AUC =0.740, maximum model AUC =0.774 (P>0.05). Includes: Technique used (P=0.024), height (P=0.043) and disorders of interventricular conduction, right bundle branch block (P=0.005), trifascicular block (P=0.008). Conclusions In our experience, the modified technique significantly decreases the incidence of postoperative atrioventricular block that requires a permanent pacemaker in the aortic valve replacement with PERCEVAL S. The prior electrocardiographic presence of right bundle branch block, trifascicular block and the height of the patient are associated with an increased risk of blocking.
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Affiliation(s)
| | - Francisco Estévez-Cid
- Department of Cardiac Surgery, A Coruña University Hospital Complex, A Coruña, Spain
| | | | | | - Carmen Iglesias Gil
- Department of Cardiac Surgery, A Coruña University Hospital Complex, A Coruña, Spain
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18
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Durdu MS, Gumus F, Ozcinar E, Cakici M, Bermede O, Dincer I, Kılıckap M, Sirlak M, Ucanok K, Akar AR. Sutureless Valve Replacement Through a Right Anterior Mini-thoracotomy in Elderly Patients With Stenotic Bicuspid Aortic Valve. Semin Thorac Cardiovasc Surg 2019; 31:458-464. [DOI: 10.1053/j.semtcvs.2018.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/26/2018] [Indexed: 11/11/2022]
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19
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Povero M, Miceli A, Pradelli L, Ferrarini M, Pinciroli M, Glauber M. Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:733-745. [PMID: 30510436 PMCID: PMC6231515 DOI: 10.2147/ceor.s185743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Meta-analyses of studies comparing transcatheter aortic valve implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show differing effectiveness and safety profiles. The approaches also differ in their surgical cost (including operating room and device). OBJECTIVE The objective of this study was to assess the incremental cost-utility of SU-AVR vs TAVIs for the treatment of intermediate- to high-risk patients in the US, Germany, France, Italy, UK, and Australia. METHODS A patient-level simulation compares in-hospital pathways of patients undergoing SU-AVR or TAVIs; later, patient history is modeled at the cohort level. Hospital outcomes for TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates in a recent meta-analysis on 1,462 patients. After discharge, survival depends on the development of paravalvular leak and the need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted. RESULTS Due to lower in-hospital (4.1% vs 7.0%) and overall mortality, patients treated with SU-AVR are expected to live an average of 1.25 years more compared with those undergoing TAVIs, with a mean gain of 1.14 quality-adjusted life-years. Both in-hospital and long-term costs were lower for SU-AVR than for TAVIs with total savings ranging from $4,158 (France) to $20,930 (US). CONCLUSION SU-AVR results dominant when compared to TAVIs in intermediate- to high-risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for the quality of life.
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Affiliation(s)
| | - Antonio Miceli
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Matteo Ferrarini
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | | | - Mattia Glauber
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
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Tam DY, Vo TX, Wijeysundera HC, Dvir D, Friedrich JO, Fremes SE. Transcatheter valve-in-valve versus redo surgical aortic valve replacement for the treatment of degenerated bioprosthetic aortic valve: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2018; 92:1404-1411. [DOI: 10.1002/ccd.27686] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/02/2018] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Derrick Y. Tam
- Division of Cardiac Surgery, Department of Surgery; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto; Toronto Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto Canada
| | - Thin X. Vo
- Division of Cardiac Surgery, Department of Surgery; University of Ottawa Heart Institute, University of Ottawa; Ottawa Canada
| | - Harindra C. Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto Canada
- Division of Cardiology, Department of Medicine; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto; Toronto Canada
| | - Danny Dvir
- Division of Cardiology Department of Medicine; University of Washington Medical Centre; Seattle Washington
| | - Jan O. Friedrich
- Critical Care and Medicine Departments; St. Michael's Hospital University of Toronto; Toronto Canada
| | - Stephen E. Fremes
- Division of Cardiac Surgery, Department of Surgery; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto; Toronto Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto Canada
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Baran C, Durdu MS, Gumus F, Cakici M, Inan MB, Sirlak M, Akar AR. Sutureless aortic valve replacement with concomitant valvular surgery. J Thorac Cardiovasc Surg 2018; 155:2414-2422. [DOI: 10.1016/j.jtcvs.2017.12.154] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 12/10/2017] [Accepted: 12/20/2017] [Indexed: 12/25/2022]
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Chauvette V, Mazine A, Bouchard D. Ten-year experience with the Perceval S sutureless prosthesis: lessons learned and future perspectives. J Vis Surg 2018; 4:87. [PMID: 29963376 DOI: 10.21037/jovs.2018.03.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 12/26/2022]
Abstract
Aortic stenosis has traditionally been addressed with surgical aortic valve replacement (AVR). In recent years, several technologies have emerged as alternative treatment methods for aortic valve disease. Among them, the Perceval (LivaNova, London, UK) is a sutureless valve that has been used in clinical practice for over 10 years. It has been implanted in over 20,000 patients worldwide. With nearly 600 Perceval implants since 2011, the Montreal Heart Institute has developed a worldwide expertise with this technology. In this article, we provide an overview of the clinical data currently available in the literature and discuss the lessons we have learned from our experience with the Perceval prosthesis.
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Affiliation(s)
- Vincent Chauvette
- Division of Cardiac Surgery, University of Montreal, Montreal, QC, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Denis Bouchard
- Division of Cardiac Surgery, Montreal Heart Institute, Montreal, QC, Canada
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Casha AR, Manché A, Camilleri L, Yamagata K, Santucci S, Gauci M, Galea J. Sutureless Perceval aortic valve implantation compared with conventional Mitroflow valve replacement. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0592-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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D'Onofrio A, Fabozzo A, Gerosa G. Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients. Ann Cardiothorac Surg 2017; 6:510-515. [PMID: 29062747 DOI: 10.21037/acs.2017.09.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current surgical treatment options for aortic valve stenosis (AS), as alternatives to that of conventional operation with a midline sternotomy, include sutureless valve replacement (SUAVR) and transcatheter valve implantation (TAVI). Patients with high surgical risk, or those who are judged to be inoperable, are typically good candidates for the TAVI procedure. The best treatment option in patients with an intermediate risk profile, however, the so called "grey zone", is still currently under debate. Sutureless aortic valve replacement has been recently presented as a valid alternative for patients with low- to intermediate-risk. Data available on prostheses' hemodynamic performance and patients' clinical outcomes play a crucial role in the process of device selection. Compared to TAVI, SUAVR provides lower rate of significant postoperative paravalvular leak (PVL), which has shown to be a predictor for mortality. On the contrary, transcatheter valves seem to perform better in terms of transvalvular mean and peak gradients. Therefore, SUAVR and TAVI are both reliable options in patients with severe aortic valve stenosis, as an alternative to conventional surgery, and the choice of the best device should be tailored to patient's anatomical and surgical characteristics.
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Affiliation(s)
| | - Assunta Fabozzo
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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