Aortic Valve Replacement Through Right Anterior Minithoracotomy: Can Sutureless Technology Improve Clinical Outcomes?

Gilmanov, Daniyar; Miceli, Antonio; Ferrarini, Matteo; Farneti, Pier Andrea; Murzi, Michele; Solinas, Marco; Glauber, Mattia

doi:10.1016/j.athoracsur.2014.05.092

Cited by 78 publications

(99 citation statements)

References 30 publications

(33 reference statements)

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“…However, owing to longer cross-clamp times and cardiopulmonary bypass times caused by the higher grade of complexity of the procedure,15 these approaches did not gain wide popularity, although even the use of various pericardial and porcine stentless valves proved to be possible through ministernotomy 16. Meanwhile, the Perceval Sutureless valve (Sorin/LivaNova Group, Saluggia, Italy), the EDWARDS INTUITY Elite (Edwards Lifesciences, Corp, Irvine, CA USA), and the Medtronic 3F Enable Bioprosthesis (Medtronic, Inc, Minneapolis, MN USA) have proven their suitability for different minimally invasive approaches to reduce aortic cross-clamp time in a prospective, nonrandomized trial17 and one prospective randomized study,18 thus reducing perioperative risk of the patients in nonrandomized trials 19,20. A recent systematic review and meta-analysis on 12 studies using Perceval Sutureless valve, Medtronic 3F Enable, or EDWARDS INTUITY confirmed that sutureless aortic valve implantation is a safe procedure associated with shorter cross-clamp and cardiopulmonary bypass time compared to conventional approaches 21.…”

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confidence: 99%

International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

Glauber

Moten

Quaini

et al. 2016

Innovations�(Phila)

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Objective To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement. Methods A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach. Results No guideline could be retrieved. Thirty-three clinical trials and 9 systematic reviews could be identified for detailed text analysis to obtain a total of 24 recommendations. After rating by the experts 12, final recommendations were identified: preoperative computed to-mographic scan as well as intraoperative transesophageal echocardiography are highly recommended. Suitable annular sizes are 19 to 27 mm. There is a contraindication for bicuspid valves only for type 0 and for annular abscess or destruction due to infective endocarditis. The use of sutureless and rapid deployment valves reduces extracorporeal circulation and aortic cross-clamp time and leads to less early complications as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions, paravalvular leakages and aortic regurgitation, and renal replacement therapy, respectively. These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs. The use of sutureless and rapid deployment valves will lead to a higher adoption rate of minimally invasive approaches in aortic valve replacement. Respect should be taken to a necessary short learning curve for both sutureless and minimally invasive programs. Conclusions Sutureless and rapid deployment aortic valve replacement together with minimally invasive approaches offers an attractive option in aortic valve placement for patients requiring biological valve replacement.

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confidence: 99%

International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

Glauber

Moten

Quaini

et al. 2016

Innovations�(Phila)

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“…The reliability of the Perceval sutureless bioprosthesis for aortic valve replacement has been already demonstrated . Initially, this valve prosthesis was implanted mostly in very elderly or in those patients with severe comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Sutureless aortic valve bioprostheses have been developed to overcome the inherent increased risk of surgical AVR by reducing the aortic cross‐clamping time. The Perceval sutureless bioprosthesis (LivaNova Biomedica Cardio Srl, Saluggia, Italy) demonstrated excellent immediate results in patients at intermediate operative risk . However, hemodynamics of this valve prosthesis has been described in vivo only at rest and, to the best of our knowledge, there are no data on the hemodynamic performance of Perceval sutureless bioprosthesis under high workload conditions at mid‐term follow‐up.…”

Section: Introductionmentioning

confidence: 99%

“…The Perceval sutureless bioprosthesis (LivaNova Biomedica Cardio Srl, Saluggia, Italy) demonstrated excellent immediate results in patients at intermediate operative risk. [1][2][3] However, hemodynamics of this valve prosthesis has been described in vivo only at rest and, to the best of our knowledge, there are no data on the hemodynamic performance of Perceval sutureless bioprosthesis under high workload conditions at mid-term follow-up. We sought to compare follow-up echocardiographic findings of Perceval sutureless bioprosthesis to preoperative and discharge records, and to evaluate the valve hemodynamics at rest and under stress at mid-term follow-up.…”

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Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

et al. 2017

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Objectives:The aim of this study was to evaluate the hemodynamic performance of a sutureless bioprosthesis under high workload at mid-term follow-up. Methods:Thirty-two patients who underwent isolated aortic valve replacement with a Perceval sutureless bioprosthesis with a minimum follow-up of 1 year were enrolled in this study. S size prosthesis was deployed in 10 patients (31.3%), M size in 9 (28.1%), L size in 8 (25%) and XL size in 5 (15.6%). Effective orifice area (EOA), EOA index (EOAi), and transvalvular gradients were assessed at rest and during dobutamine stress echocardiography (DSE) a median of 19.5 months after surgery.Results: Dobutamine stress echocardiography (DSE) significantly increased heart rate, stroke volume, ejection fraction, and transvalvular gradients (peak gradient, 24.0 ± 7.6 vs 38.7 ± 13.6 mm Hg, P < .001; mean gradient, 12.6 ± 4.2 vs 19.8 ± 8.3, P < .001).When compared to baseline, estimated valve areas significantly increased at follow-up (EOA, 1.48 ± 0.46 vs 2.06 ± 0.67, P < .001; EOAi, 0.84 ± 0.26 vs 1.17 ± 0.37, P < .001).Mean percentage increase in EOAi was 40.3% ± 28.0%. S size prostheses had the highest increase in EOA1, but the difference was not significant (S 46.0% ± 27.5% vs M 45.4% ± 34.5% vs L 32.7% ± 26.4% vs XL 32.1% ± 20.5%, P = .66). Severe patientprosthesis mismatch (EOAi ≤ 0.65 cm 2 /m 2 ) was present at rest in 8 patients (25%), but only in one patient (3.1%) during DSE. Conclusions:The Perceval sutureless bioprosthesis demonstrated good hemodynamics at rest and under high workload. The significant increase in EOAi during DSE suggests the potential advantages of Perceval sutureless bioprostheses in case of small aortic annulus or when patient-prosthesis mismatch is anticipated. K E Y W O R D Saortic valve prosthesis, aortic valve replacement, dobutamine stress echocardiography, sutureless

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“…Compared with traditional prosthesis implantation via RAMT, the transition to a sutureless valve resulted in shorter crossclamp and bypass times. 4 …”

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confidence: 99%

Institutional or individual experience matters in minimally invasive valve surgery

Hawkins

Ailawadi

2016

The Journal of Thoracic and Cardiovascular Surgery

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Aortic Valve Replacement Through Right Anterior Minithoracotomy: Can Sutureless Technology Improve Clinical Outcomes?

Cited by 78 publications

References 30 publications

International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

Institutional or individual experience matters in minimally invasive valve surgery

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