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Vendramin I, Bortolotti U, Livi U. Simplifying complex aortic root reoperations. JTCVS Tech 2024; 26:21. [PMID: 39156528 PMCID: PMC11329175 DOI: 10.1016/j.xjtc.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
| | | | - Ugolino Livi
- Cardiothoracic Department, University Hospital, Udine, Italy
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Müller H, Szalkiewicz P, Benedikt P, Ratschiller T, Schachner B, Schröckenstein S, Zierer A. Single-center real-world data and technical considerations from 100 consecutive patients treated with the Perceval aortic bioprosthesis. Front Cardiovasc Med 2024; 11:1417617. [PMID: 39070555 PMCID: PMC11272482 DOI: 10.3389/fcvm.2024.1417617] [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: 04/15/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024] Open
Abstract
Objectives Although the Perceval sutureless aortic valve bioprosthesis presents a feasible alternative to conventional aortic valve prostheses, the extent of its applicability with respect to technical considerations for a real-world patient collective is still under debate. Methods One hundred patients received the Perceval prosthesis [males: 59; age: 72.5 (7.3-79) years] between December 2015 and February 2023 [EuroSCORE II: 2.8 (1.7-5.4)] for an aortic valve replacement (AVR), with additional concomitant procedures, for underlying severe aortic valve stenosis [n = 93 (93)], endocarditis [n = 5 (5)], and redo AVR [n = 7 (7)] including a prior surgical AVR [n = 4 (4)] and a failed transcatheter aortic valve implantation [n = 3 (3)]. Surgery was conducted primarily by median sternotomy [n = 71 (71)] and, alternatively, by the upper hemisternotomy approach [n = 29 (29)]. Results Over a median follow-up time of 36.5 (16.5-53) months, eight patients (8%) underwent postoperative pacemaker implantation, with five (5%) due to high-grade atrioventricular block, while nine patients experienced a stroke (9%). The median values of maximum and mean gradients across all valve sizes were 22 (18-27.5) mmHg and 10 (13-18) mmHg, respectively. Two patients (2%) had moderate and one (1%) had severe paravalvular leakage, with the latter presenting the only case of underlying valve migration and induced redo AVR with valve explantation 2 days following initial surgery. Thirty-day mortality (and overall mortality) was 5% and 26%, respectively. Conclusion The implantation of the Perceval bioprosthesis is feasible for a variety of indications, with excellent hemodynamic results and low complication rates in a real-world high-risk patient collective.
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Affiliation(s)
| | - Philipp Szalkiewicz
- Department of Cardio-Vascular and Thoracic Surgery, Kepler University Hospital—Faculty of Medicine, Johannes Kepler University, Linz, Austria
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Yanagino Y, Kawamoto N, Kainuma S, Tadokoro N, Kakuta T, Ikuta A, Tonai K, Fujita T, Fukushima S. Successful Implantation of Rapid Deployment Aortic Valve after TAVR Explantation. J Cardiothorac Surg 2024; 19:211. [PMID: 38616249 PMCID: PMC11017536 DOI: 10.1186/s13019-024-02728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/29/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become widely used in recent years, However, there is also an increasing need for removal of TAVR valves due to prosthetic valve dysfunction (PVD) and the development of infective endocarditis. Surgical aortic valve replacement (AVR) for these patients is risky due to the original patient background and anatomic conditions. Intuity rapid deployment aortic valve (Edwards Lifesciences, Irvine, CA) replacement would be useful for such high risk patients to prevent longer cardiac arrest time and obtain good hemodynamic results. However, there are few reports which present Intuity valve replacement after TAVR explantation. Herein, We report two cases in which we have achieved good hemodynamics with shorter cardiac arrest times by using a rapid deployment valve after TAVR explantation. CASE PRESENTATION We present 2 cases of successful implantation of the Intuity rapid deployment valve after TAVR explantation. The 84- and 88-year-old female patients had previously received TAVR for severe aortic stenosis with SAPIEN XT (Edwards Lifesciences, Irvine, CA) and developed PVD during follow-up. The TAVR valve was removed carefully, then an Intuity valve was implanted with cardiac arrest times of 69 and 41 min. Both patients had good echocardiographic results with effective orifice area of 2.0 cm2 and 1.2 cm2 and mean trans-aortic plessure gradient of 9 mmHg and 15 mmHg respectively without aortic regurgitation. They were discharged without major complications. CONCLUSIONS Surgical AVR using a rapid deployment valve is a useful alternative to sutured AVR after TAVR valve explantation. It allows for shorter cardiac arrest times and better postoperative hemodynamics without major complication.
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Affiliation(s)
- Yusuke Yanagino
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan.
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Ayumi Ikuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Kohei Tonai
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
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Cummings I, Salmasi MY, Bulut HI, Zientara A, AlShiekh M, Asimakopoulos G. Sutureless Biological Aortic Valve Replacement (Su-AVR) in Redo operations: a retrospective real-world experience report of clinical and echocardiographic outcomes. BMC Cardiovasc Disord 2024; 24:28. [PMID: 38172707 PMCID: PMC10765636 DOI: 10.1186/s12872-023-03652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This retrospective study aimed to compare the outcomes of sutureless aortic valve replacement (su-AVR) and conventional bioprosthetic sutured AVR (cAVR) in high-risk patients undergoing redo surgery. METHODS A total of 79 patients who underwent redo AVR between 2014 and 2021 were included in the study. Of these, 27 patients underwent su-AVR and 52 underwent cAVR. Patient characteristics and clinical outcomes were analysed using multivariate regression and Kaplan Meier survival test. RESULTS The groups were similar in terms of age, gender, left ventricular function, and number of previous sternotomies. In cases of isolated AVR, su-AVR had significantly lower cross clamp times than cAVR (71 vs. 86 min, p = 0.03). Postoperatively, 4 cAVR patients required pacemaker compared to zero patients in the su-AVR group. There were no significant differences between the two groups in terms of postoperative complications, intrahospital stay (median 9 days, IQR 7-20), or in-hospital mortality (1 su-AVR; 2 cAVR). The long-term survival rate was similar between the su-AVR (90%) and cAVR (92%) groups (log rank p = 0.8). The transvalvular gradients at follow-up were not affected by the type of valve used, regardless of the valve size (coef 2.68, 95%CI -3.14-8.50, p = 0.36). CONCLUSION The study suggests that su-AVR is a feasible and safe alternative to cAVR in high-risk patients undergoing redo surgery. The use of su-AVR offers comparable outcomes to cAVR, with reduced cross clamp times and a lower incidence of postoperative pacemaker requirement in isolated AVR cases. The results of this study contribute to the growing body of evidence supporting the use of su-AVR in high-risk patients, highlighting its feasibility and safety in redo surgeries.
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Affiliation(s)
- Ian Cummings
- Department of Cardiac Surgery, St Thomas Hospital, London, UK
| | - M Yousuf Salmasi
- Department of Surgery, Imperial College London, QEQM Building, South Wharf Road, London, UK.
| | - Halil Ibrahim Bulut
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alicja Zientara
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mahmoud AlShiekh
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - George Asimakopoulos
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Zubarevich A, Beltsios ET, Arjomandi Rad A, Amanov L, Szczechowicz M, Ruhparwar A, Weymann A. Sutureless Aortic Valve Prosthesis in Redo Procedures: Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1126. [PMID: 37374330 DOI: 10.3390/medicina59061126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Sutureless aortic valve prostheses have presented favorable hemodynamic performance while facilitating minimally invasive access approaches. As the population ages, the number of patients at risk for aortic valve reoperation constantly increases. The aim of the present study is to present our single-center experience in sutureless aortic valve replacement (SU-AVR) in reoperations. Materials and Methods: The data of 18 consecutive patients who underwent SU-AVR in a reoperation between May 2020 and January 2023 were retrospectively analyzed. Results: The mean age of the patients was 67.9 ± 11.1 years; patients showed a moderate-risk profile with a median logistic EuroSCORE II of 7.8 (IQR of 3.8-32.0) %. The implantation of the Perceval S prosthesis was technically successful in all patients. The mean cardiopulmonary bypass time was 103.3 ± 50.0 min, and the cross-clamp time was 69.1 ± 38.8 min. No patients required a permanent pacemaker implantation. The postoperative gradient was 7.3 ± 2.4 mmHg, and no cases of paravalvular leakage were observed. There was one case of intraprocedural death, while the thirty-day mortality was 11%. Conclusions: Sutureless bioprosthetic valves tend to simplify the surgical procedure of a redo AVR. By maximizing the effective orifice area, sutureless valves may present an important advantage, being a safe and effective alternative not only to traditional surgical prostheses but also to transcatheter valve-in-valve approaches in select cases.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
| | - Eleftherios T Beltsios
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | | | - Lukman Amanov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
| | - Arjang Ruhparwar
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
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Falcetta G, Del Re F, Pratali S, Bortolotti U. Replacement of a Calcified Aortic Valve in a Porcine Aortic Root with the Perceval Sutureless Bioprosthesis. AORTA (STAMFORD, CONN.) 2022; 10:302-303. [PMID: 36539148 PMCID: PMC9767758 DOI: 10.1055/s-0042-1757795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report a 79-year-old patient who had aortic valve replacement (AVR) using a porcine aortic root. Due to degeneration of the porcine aortic valve, he required reoperation during which a heavily calcified porcine root and aortic annulus prevented insertion of any traditional bioprosthesis. AVR was achieved using a sutureless bioprosthesis, combined with mitral valve replacement. The present case confirms the feasibility and advantages of using sutureless valve implantation in complex and high-risk redo procedures.
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Affiliation(s)
- Giosuè Falcetta
- Section of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Surgery, University Hospital, Pisa, Italy
| | - Federico Del Re
- Section of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Surgery, University Hospital, Pisa, Italy
| | - Stefano Pratali
- Section of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Surgery, University Hospital, Pisa, Italy
| | - Uberto Bortolotti
- Section of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Surgery, University Hospital, Pisa, Italy,Address for correspondence Uberto Bortolotti, MD Largo Traiano 23, 35036 Montegrotto TermeItaly
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Vendramin I, Bortolotti U, Livi U. Sutureless bioprostheses for aortic valve reoperations: How to get out of troubles. JTCVS Tech 2022; 16:25. [PMID: 36510553 PMCID: PMC9735317 DOI: 10.1016/j.xjtc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
| | | | - Ugolino Livi
- Cardiothoracic Department, University Hospital, Udine, Italy
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Bortolotti U, Vendramin I, Livi U. SURGICAL AORTIC VALVE REPLACEMENT optimizing the small aortic annulus size. Eur J Cardiothorac Surg 2022; 62:6572343. [PMID: 35451461 DOI: 10.1093/ejcts/ezac256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Uberto Bortolotti
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
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Yarboro LT. The Role of Sutureless Aortic Valves in the Treatment of Severe Aortic Stenosis. JACC. ASIA 2021; 1:330-331. [PMID: 36341206 PMCID: PMC9627919 DOI: 10.1016/j.jacasi.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Leora T. Yarboro
- Address for correspondence: Dr Leora T. Yarboro, Department of Surgery, University of Virginia, P.O. Box 800679, Charlottesville, Virginia 22908-0679, USA.
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Singh N, Chaudhuri K, Nand P. Long-term durability of a Perceval aortic valve implanted inside a calcified homograft root in a patient with Klippel-Trenaunay-Weber syndrome. J Card Surg 2021; 37:242-244. [PMID: 34662465 DOI: 10.1111/jocs.16091] [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: 08/25/2021] [Revised: 09/26/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Perceval valves are sutureless surgical bioprostheses designed for the aortic position. We report on the use of a Perceval sutureless valve for redo aortic valve replacement inside a heavily calcified homograft root in a patient with Klippel-Trenaunay-Weber syndrome. MATERIALS AND METHODS Anonymized patient case data was extracted from hospital electronic records. RESULTS A now 62-year-old woman with Klippel-Trenaunay-Weber syndrome underwent homograft aortic root replacement for congenital aortic valve dysplasia when she was 39 years old. She re-presented in 2012 with severe symptomatic aortic regurgitation through the homograft root. Computed tomography scanning revealed a heavily calcified homograft root. In order to avoid a high-risk redo root replacement or a challenging sutured aortic valve replacement, she underwent Perceval sutureless aortic valve implantation. As of 9.5 years following Perceval implantation, the bioprosthetic valve function remains excellent, with no transvalvular regurgitation seen. DISCUSSION AND CONCLUSION This case reveals the value of Perceval valve implantation in redo surgery inside a hostile calcified homograft aortic root. Furthermore, we highlight the long-term durability of the Perceval sutureless bioprosthesis.
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Affiliation(s)
- Navneet Singh
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Krish Chaudhuri
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Parma Nand
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
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Vendramin I, Bortolotti U, Livi U. Transcatheter aortic valve replacement after valve-sparing aortic root surgery. J Card Surg 2021; 36:4434. [PMID: 34374119 DOI: 10.1111/jocs.15900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Igor Vendramin
- Department of Cardiothoracic, University Hospital, Udine, Italy
| | | | - Ugolino Livi
- Department of Cardiothoracic, University Hospital, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
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