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Schizas N, Samiotis I, Nazou G, Iliopoulos DC, Anagnostopoulos I, Kousta M, Papaioannou N, Argiriou M, Dedeilias P. Perceval-S over time. Clinical outcomes after ten years of usage. J Cardiothorac Surg 2024; 19:192. [PMID: 38594705 PMCID: PMC11003077 DOI: 10.1186/s13019-024-02617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Perceval-S has become a reliable and commonly used option in surgical aortic valve replacement (AVR) since its first implantation in humans 15 years ago. Despite the fact that this aortic valve has been proven efficient enough in the short and mid-term period, there is still lack of evidence for the long-term outcomes. MATERIALS AND METHODS This is an observational retrospective study in a high-volume cardiovascular center. Pertinent data were collected for all the patients in whom Perceval-S was implanted from 2013 to 2020. RESULTS The total number of patients was 205 with a mean age 76.4 years. Mean survival time was 5.5 years (SE = 0.26). The overall survival probability of patients undergoing aortic valve replacement with Perceval-S at 6 months was 91.0% (Standard Error SE = 2.0%), at one year 88.4% (SE = 2.3%) and at 5-years 64.8% (SE = 4.4%). A detrimental cardiac event leading to death was the probable cause of death in 35 patients (55.6%). The initiation of Transcatheter Aortic Valve Replacement (TAVR) program in our center in 2017 was associated with a decline in the number of very high-risk patients treated with sutureless bioprosthesis. This fact is demonstrated by the significant shift towards lower surgical risk cases, as median Euroscore II was reduced from 5,550 in 2016 to 3,390 in 2020. Mini sternotomy was implemented in 79,5% of cases favoring less invasive approach. Low incidence of reinterventions, patient prosthesis mismatch and structural valve degeneration was detected. CONCLUSIONS The survival rate after aortic valve replacement with implantation of Perceval-S is satisfactory in the long-term follow-up. Cases of bioprosthesis dysfunction were limited. Mini sternotomy was used in the majority of cases. TAVR initiation program impacted on the proportion of patients treated with Perceval-S with reduction of high-risk patients submitted to surgery.
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Affiliation(s)
- Nikolaos Schizas
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Athens, Greece.
| | - Ilias Samiotis
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Athens, Greece
| | - Georgia Nazou
- Department of Anesthesiology, Evangelismos General Hospital, Athens, Greece
| | | | | | - Maria Kousta
- Department of Cardiology, G. Gennimatas General Hospital, Athens, Greece
| | - Nafsika Papaioannou
- Environmental Engineering Laboratory, Aristotle University, Thessaloniki, Greece
| | - Mihalis Argiriou
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Athens, Greece
| | - Panagiotis Dedeilias
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Athens, Greece
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Dokollari A, Torregrossa G, Sicouri S, Cameli M, Mandoli GE, Kjelstrom S, Prifti E, Veshti A, Bonacchi M, Gelsomino S. Long-term prognosis in patients undergoing redo-isolated aortic valve replacement. Future Cardiol 2023; 19:685-694. [PMID: 38078413 DOI: 10.2217/fca-2023-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
Aim: To evaluate clinical outcomes after redo aortic valve replacement (AVR) with sutured valves, versus valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), versus sutureless valves. Methods: We identified 113 consecutive patients undergoing redo AVR with either ViV-TAVR, redo-sutured and redo-sutureless valves between August 2010 to March 2020. Heart-team made the decision whether patient should undergo redo-sutureless versus ViV-TAVR, versus redo-sutured AVR. Results: Preoperatively, redo-sutured (n = 57), ViV-TAVR (n = 31) and redo-sutureless (n = 25) patients were compared. Postoperatively, after propensity-adjustment analysis, the redo surgical aortic valve replacement group had a higher incidence of new postoperative atrial fibrillation (POAF; p = 0.04) compared with redo-sutureless group. Follow-up outcomes analysis did not show differences among groups. Conclusion: Patients undergoing redo-sutureless AVR experienced a higher incidence of POAF compared with patients undergoing redo-sutured.
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Affiliation(s)
- Aleksander Dokollari
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg M3B1W7, Canada
| | | | - Serge Sicouri
- Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | | | - Edvin Prifti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana Albania
| | - Altin Veshti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana Albania
| | - Massimo Bonacchi
- Department of Experimental & Clinical Medicine, University of Florence, Firenze, Italy
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
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Quinn RD. The 10 Commandments of Perceval Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:299-307. [PMID: 37585810 DOI: 10.1177/15569845231191525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Reed D Quinn
- Cardiovascular Surgery, Maine Medical Center, Portland, ME, 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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Bociański M, Puślecki M, Olasińska-Wiśniewska A, Perek B, Stefaniak S, Buczkowski P, Jemielity M. A comparative study of minimally invasive aortic valve replacement with sutureless biological versus mechanical prostheses. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2023; 20:77-82. [PMID: 37564970 PMCID: PMC10410630 DOI: 10.5114/kitp.2023.129542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/25/2023] [Indexed: 08/12/2023]
Abstract
Introduction The ministernotomy approach with sutureless aortic bioprosthesis may provide an attractive and safe option for aortic valve disease patients. Aim To assess the early and mid-term outcomes of minimally invasive aortic valve replacement (miniAVR) with sutureless vs. standard prostheses. Material and methods The study involved 76 consecutive patients (51 males and 25 females) with mean age of 63.2 years who were treated with miniAVR between 2015 and 2022. They were divided into 2 subgroups: group I (n = 40) subjects with sutureless bioprostheses and group II (n = 36) with standard prostheses implanted. Early and mid-term outcomes were evaluated. A probability of survival was estimated by means of the Kaplan-Meier method. Results No conversion to complete sternotomy was necessary. The median (minimum; maximum) aorta cross clamping and cardio-pulmonary bypass times were 49 (27; 84) and 70 (40; 188) minutes in group I whereas 69 (50; 103) and 95 (69; 170) minutes in group II, respectively (p < 0.001). In-hospital mortality was 5.0% (n = 2) and 2.8% (n = 1) in group I vs. II, respectively (ns). Permanent ICD implantation was performed in 8 (20.0%) in group I and in 3 (8.3%) subjects in group II. In the discharge echocardiography, the function of all prostheses was correct. Five-year probability of survival was much lower in group I (0.75 ±0.10) than in group II (0.94 ±0.04). No wound infection or sternum instability was noted. Conclusions Intraoperative advantages of miniAVR procedures for aortic valve patients with sutureless bioprostheses do not translate directly into improved early and middle-term outcomes.
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Affiliation(s)
- Michał Bociański
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Puślecki
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
- Department of Medical Rescue, Chair of Rescue Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasińska-Wiśniewska
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Sebastian Stefaniak
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Buczkowski
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Kaitovic M, Micovic S, Nesic I, Raickovic T, Dotlic J, Stojanovic I, Gazibara T. An Analysis of Early Results after Valve Replacement in Isolated Aortic Valve Stenosis by Using Sutureless vs. Stented Bioprostheses: A Single-Center Middle-Income Country Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1032. [PMID: 37374235 DOI: 10.3390/medicina59061032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: There is a lack of data about the survival of patients after the implantation of sutureless relative to stented bioprostheses in middle-income settings. The objective of this study was to compare the survival of people with isolated severe aortic stenosis after the implantation of sutureless and stented bioprostheses in a tertiary referral center in Serbia. Materials and Methods: This retrospective cohort study included all people treated for isolated severe aortic stenosis with sutureless and stented bioprostheses from 1 January 2018 to 1 July 2021 at the Institute for Cardiovascular Diseases "Dedinje". Demographic, clinical, perioperative and postoperative data were extracted from the medical records. The follow-up lasted for a median of 2 years. Results: The study sample comprised a total of 238 people with a stented (conventional) bioprosthesis and 101 people with a sutureless bioprosthesis (Perceval). Over the follow-up, 13.9% of people who received the conventional and 10.9% of people who received the Perceval valve died (p = 0.400). No difference in the overall survival was observed (p = 0.797). The multivariate Cox proportional hazard model suggested that being older, having a higher preoperative EuroScore II, having a stroke over the follow-up period and having valve-related complications were independently associated with all-cause mortality over a median of 2 years after the bioprosthesis implantation. Conclusions: This research conducted in a middle-income country supports previous findings in high-income countries regarding the survival of people with sutureless and stented valves. Survival after bioprosthesis implantation should be monitored long-term to ensure optimum postoperative outcomes.
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Affiliation(s)
- Marko Kaitovic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Slobodan Micovic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Nesic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tatjana Raickovic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
| | - Jelena Dotlic
- Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, 11000 Belgrade, Serbia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Stojanovic
- Cardiac Surgery Department, Institute for Cardiovascular Diseases "Dedinje", 11040 Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Dokollari A, Torregrossa G, Bisleri G, Hassanabad AF, Sa MP, Sicouri S, Veshti A, Prifti E, Bacchi B, Cabrucci F, Ramlawi B, Bonacchi M. Early and Long-Term Clinical and Echocardiographic Outcomes of Sutureless vs. Sutured Bioprosthesis for Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:jcdd10050224. [PMID: 37233191 DOI: 10.3390/jcdd10050224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
Objective: The goal of this manuscript is to compare clinical and echocardiographic outcomes of patients undergoing aortic valve replacement (AVR) with Perceval sutureless bioprosthesis (SU-AVR) and sutured bioprosthesis (SB). Methods: Following the PRISMA statement, data were extracted from studies published after August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post-procedural permanent pacemaker implantation, and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop-out), need for a second transcatheter heart valve, 30-day mortality, stroke, and echocardiographic outcomes. Results: Twenty-one studies were included in the analysis. When SU-AVR was compared to other SB, mortality ranged from 0 to 6.4% for Perceval and 0 to 5.9% for SB. Incidence of PVL (Perceval 1-19.4% vs. SB 0-1%), PPI (Perceval 2-10.7% vs. SB 1.8-8.5%), and MI (Perceval 0-7.8% vs. SB 0-4.3%) were comparable. In addition, the stroke rate was lower in the SU-AVR group when compared to SB (Perceval 0-3.7% vs. SB 1.8-7.3%). In patients with a bicuspid aortic valve, the mortality rate was 0-4% and PVL incidence was 0-2.3%. Long-term survival ranged between 96.7 and 98.6%. Valve cost analysis was lower for the Perceval valve and higher for sutured bioprosthesis. Conclusions: Compared to SB valves, Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its non-inferior hemodynamics, implantation speed, reduced cardiopulmonary bypass time, reduced aortic cross-clamp time, and shorter length of stay.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | | | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| | - Michel Pompeu Sa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Altin Veshti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Edvin Prifti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Beatrice Bacchi
- St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Francesco Cabrucci
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Massimo Bonacchi
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
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Sonaglioni A, Grasso E, Nicolosi GL, Trevisan R, Martinelli GL, Lombardo M. An Unusual Case of Ascending Aorta Dissection 4 Years after Perceval Sutureless Bioprosthesis Implantation: Easier Access to Diagnosis through the Right Parasternal Longitudinal Echocardiographic Window. J Cardiovasc Echogr 2023; 33:98-101. [PMID: 37772053 PMCID: PMC10529284 DOI: 10.4103/jcecho.jcecho_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 09/30/2023] Open
Abstract
Sutureless bioprostheses are more frequently used for the surgical treatment of elderly patients with high burden of comorbidity, who are candidates to aortic valve replacement (AVR). Among the sutureless bioprostheses, the Perceval valve has shown a good midterm durability, with very few reports of valve deterioration and low risk of complications. Herein, we present an unusual case of ascending aorta dissection which occurred 4 years after AVR with a Perceval sutureless pericardial bioprosthesis, likely related to the peculiar prosthetic design. A high right parasternal longitudinal view of the aorta in the right lateral decubitus allowed to suspect the acute aortic syndrome, thus accelerating the subsequent diagnostic and therapeutic iter.
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Affiliation(s)
- Andrea Sonaglioni
- Division of Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Enzo Grasso
- Division of Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | | | - Roberta Trevisan
- Division of Radiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Gian Luca Martinelli
- Division of Cardiac Surgery, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Michele Lombardo
- Division of Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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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.
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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
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10
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Dokollari A, Torregrossa G, Sicouri S, Veshti A, Margaryan R, Cameli M, Mandoli GE, Maccherini M, Montesi G, Cabrucci F, Coku L, Arora R, Li QR, Bonacchi M, Gelsomino S. Pearls, pitfalls, and surgical indications of the Intuity TM heart valve: A rapid deployment bioprosthesis. A systematic review of the literature. J Card Surg 2022; 37:5411-5417. [PMID: 36403259 DOI: 10.1111/jocs.17231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To highlight short- and long-term clinical outcomes of the Intuity TM rapid deployment prosthesis for surgical aortic valve replacement. METHODS We reviewed on PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL, and Google Scholar for clinical trials, retrospective clinical studies, meta-analysis, and gray literature. RESULTS Fourty-five clinical studies with 12.714 patients were included in the analysis. Thirty-day mortality ranged from 3.8% for Intuity and 3.9% for transcatheter aortic valve replacement (TAVR). The incidence of paravalvular leak (PVL) (Intuity 0% and TAVR 2.17%), permanent pacemaker implantation (Intuity 11.11% and TAVR 12.5%), stroke (Intuity 2.2% and TAVR 2.6%), myocardial infarction (MI) (Intuity 0% and TAVR 1%), were all higher in the TAVR group. Compared to other sutured bioprosthesis (SB), mortality ranged from 0% to 3.9% for Intuity and 0%-6.9% for SB. Long-term cardiac mortality ranged from 0.9% to 1.55% for Intuity and 1.4%-3.3% for the Perceval valve. The incidence of PVL (Intuity 0.24%-0.7% and Perceval 0%-1%), endocarditis (Intuity 0.2%-0.7% and Perceval 1.6%-6.6%), stroke (Intuity 0.36%-1.4% and Perceval 0%-0.8%), MI (Intuity 0.07%-0.26%), and SVD (Intuity 0.12%-0.7% and Perceval 0%) were comparable. Compared to standard full sternotomy (SFS), minimally invasive surgery (MINV) mortality ranged from 0% to 4.3% for MINV and 0%-2.1% for SFS. Hospital costs outcomes ranged from $37,187-$44,368 for the Intuity, $69,389 for TAVR, and $13,543 for SB. Intuity short-term mortality ranged between 0.9% and 12.4% while long-term mortality ranged between 2.6% and 20%. CONCLUSIONS This manuscript provides a 360° overview of the current rapid deployments, sutureless, and TAVR prosthesis.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Altin Veshti
- Department of Cardiac Surgery, Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Matteo Cameli
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Giulia Elena Mandoli
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Massimo Maccherini
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Gianfranco Montesi
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Francesco Cabrucci
- Department of Cardiac Surgery/Cardiology, University of Siena, Siena, Italy
| | - Lindita Coku
- Department of Cardiac Surgery, Appalachian Regional Health, University of Kentucky, Hazard, Kentucky, USA
| | - Rakesh Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Qiao Ri Li
- 2010 Vision Associates, Toronto, Ontario, Canada
| | - Massimo Bonacchi
- Department of Cardiac Surgery/Cardiology, University of Siena, Siena, Italy
| | - Sandro Gelsomino
- Department of Cardiac Surgery, CARIM Maastricht Medical University, Maastricht, Netherlands
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11
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Sá MP, Van den Eynde J, Erten O, Sicouri S, Ramlawi B. Sternal-sparing aortic valve replacement with sutureless valve in bicuspid valve. J Card Surg 2022; 37:5653-5662. [PMID: 36378946 DOI: 10.1111/jocs.17185] [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: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
Over the last decade, sutureless valves (Perceval, LivaNova PLC) were brought to the market as an alternative to stented valves for patients requiring surgical aortic valve replacement (SAVR). However, Perceval demands special steps for implantation, among which we can mention specific training for the surgical team members. Sternal-sparing cardiac procedures are conceived to limit surgical trauma, but the technical requirements and preoperative planning are more challenging than those for conventional sternotomy. SAVR is frequently carried out through an upper hemisternotomy, but the right anterior thoracotomy (RAT) represents an even less traumatic, technical advancement. In the context of SAVR with RAT, Perceval has been considered the "perfect marriage." In patients with bicuspid aortic valve (BAV), some surgeons initially avoided the Perceval valve but, with growing experience, the prosthesis has been used for a wide variety of indications. According to an international consensus statement recently published, there are 3 BAV types: the fused BAV, the 2-sinus BAV and the partial-fusion BAV, each with specific phenotypes. The 2-sinus BAV has 2 cusps, roughly equal in size and shape, each cusp occupying 180° of the annular circumference, with only 2 aortic sinuses, resulting in a 2-sinus/2-cusp valve without raphe and with 180° commissural angles. Since the elliptic aortic annulus in BAV patients poses a challenge for sutureless valves and the RAT approach has been increasingly adopted for minimally invasive SAVR, our description of the surgical technique focuses on the specific procedural details in the scenario of 2-sinus BAV laterolateral phenotype.
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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
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - 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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Singh N, Peek KN, Nand P. Novel use of the Perceval sutureless bioprosthesis for pulmonary valve replacement in high-risk endocarditis patients: A case series. J Card Surg 2022; 37:2159-2161. [PMID: 35238071 DOI: 10.1111/jocs.16389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
We present the first known cases of successful implantation of the Perceval sutureless bioprosthetic valve in the pulmonary position in two high-risk endocarditis patients.
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Affiliation(s)
- Navneet Singh
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Kevin N Peek
- Waikato Cardiothoracic Unit, Hamilton, New Zealand
| | - Parma Nand
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
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