European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patients

Shrestha, Malakh; Fischlein, Theodor; Meuris, Bart; Flameng, Willem; Carrel, Thierry; Madonna, Francesco; Misfeld, Martín; Folliguet, Thierry; Haverich, Axel; Laborde, F

doi:10.1093/ejcts/ezv040

Cited by 151 publications

(158 citation statements)

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“…Shrestha ve ark.nın [24] yaptıkları ve 731 hastanın beş yıl izlendiği çok merkezli çalışmada ise 30 günlük mortalite %3.4 iken 30 gün sonrası mortalite %7 olarak bulunmuştur. Bizim çalışmamızda ameliyat sonrası ikinci ayda nörolojik sorunlar nedeniyle bir hasta ve üçüncü ayda akut respiratuar distres sendromu tablosuna bağlı olarak bir hasta olmak üzere toplam iki hasta kalp dışı nedenlerle kaybedildi.…”

Section: Discussionunclassified

Early- and mid-term results of sutureless aortic valve replacement in high-risk patients: our single-center experience

Göde¹

2016

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada kalsifik ileri aort darlığı olan yüksek riskli hastalarda dikişsiz biyoprotez aort kapak replasmanının erken ve orta dönem sonuçları sunuldu. Ça lış ma pla nı: Temmuz 2014 -Temmuz 2015 tarihleri arasında üç tipten biri (3F Enable, Perceval S ve Edwards) kullanılarak dikişsiz biyoprotez aort kapak replasmanı yapılan 27 hasta (9 erkek, 18 kadın; ort. yaş 72.96±6.15 yıl; dağılım 62-85 yıl) çalışmaya alındı. Hastaların demografik verileri ve taburculuk sırasında, üçüncü ve altıncı ayda ekokardiyografi sonuçları karşılaştırıldı. Bul gu lar: Onbir hastaya aort kapak replasmanı ile birlikte koroner arter baypas greftleme yapıldı. Ortalama total perfüzyon zamanı ve aortik kros klemp zamanı sırasıyla, 84.2±33.8 dakika ve 45.2±19.2 dakika idi. Hastaların takip ekokardiyografilerinde iyi hemodinamik performans ve düşük aortik gradiyent saptandı. Üçüncü ay ve sonrasındaki ekokardiyografilerde septum kalınlığı, taburculuk ekokardiyografisine kıyasla, anlamlı olarak azaldı (p=0.008). Hastaların biri protez kapak migrasyonu, biri de ileri paravalvüler kaçak gelişmesi nedeni ile tekrar ameliyat edildi. İki hasta ise kalp dışı nedenlerden dolayı 37. ve 81. günlerde kaybedildi. So nuç: İşlem sonrası erken dönemde migrasyon ve paravalvüler kaçak gibi kapağa bağlı komplikasyonlar görülebilmekle birlikte, dikişssiz aort kapak replasmanının total perfüzyon zamanını ve aortik kross klemp zamanını azaltması en büyük avantajlarındandır.Anah tar söz cük ler: Aort kapak replasmanı; mortalite; dikişsiz aort kapak. ABSTRACTBackground:In this study, we present early-and mid-term results of sutureless bioprosthetic aortic valve replacement in high-risk patients with severe calcific aortic stenosis. Methods: Between July 2014 and July 2015, 27 patients (9 males, 18 females; mean age 72.96±6.15 years; range 62 to 85 years) who underwent sutureless bioprosthetic aortic valve replacement using one of three types (3F Enable, Perceval S, and Edwards) were included in the study. Demographic data of the patients and echocardiographic findings at discharge, three and six months were compared. Results:Eleven patients underwent aortic valve replacement in conjunction with coronary artery bypass grafting. The mean total perfusion time and aortic cross-clamp time were 84.2±33.8 min and 45.2±19.2 min, respectively. Good hemodynamic performance and low aortic gradient were detected on follow-up echocardiographies of the patients. The septal thickness was lower at three months and thereafter on echocardiography, than the discharge echocardiography (p=0.008). Two patients were reoperated due to prosthetic valve migration and advanced paravalvular leak. Two patients died due to non-cardiac causes in the 37 th and 81 st postoperative days.

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Section: Discussionunclassified

Early- and mid-term results of sutureless aortic valve replacement in high-risk patients: our single-center experience

Göde¹

2016

Turk Gogus Kalp Dama

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“…In contrast to transcatheter aortic valve replacement (TAVI), SU-AVR is performed after valve excision and results in optimal hemodynamic performance in terms of the effective valve orifice area and similar early and long-term complication rates compared to conventional aortic valve replacement requiring annular sutures [2]. A case of leakage caused by postoperative stent distortion has been reported, and stent fatigue and creep have been proposed as potential concerns [3].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with severe aortic stenosis, sutureless aortic valve replacement (SU-AVR) has emerged as a valuable technique that allows a reduction in cardiopulmonary bypass (CPB) time and global risk profile related to surgery in high-risk patients [1]. SU-AVR has been shown to provide an excellent hemodynamic profile with comparable rates of complications, including paravalvular leakage, to that of conventional aortic valve replacement while allowing a significant reduction in the aortic cross-clamp time [2]. As the stenotic calcified valve is excised before SU-AVR, intraoperative paravalvular leakage is rare and only cases of delayed postoperative stent distortion have been reported to date [3].…”

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confidence: 99%

Intraoperative paravalvular leakage after sutureless aortic valve replacement corrected with secondary balloon dilatation -A case report-

et al. 2016

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Sutureless aortic valve replacement was performed in a 72-year-old female patient with severe aortic stenosis who had undergone coronary revascularization and pacemaker implantation. After valve excision, decalcification was deliberately incompletely performed at the commissure of the left-and non-coronary cusp to obtain a regular and circular annular margin. After implantation of the stented valve, no paravalvular leakage was noted on water irrigation testing. Upon weaning from cardiopulmonary bypass, a moderate degree of paravalvular leakage was observed by transesophageal echocardiography at the junction of the left-and non-coronary cusp. Instead of removing the valve and performing more complete decalcification to implant a larger valve, secondary balloon dilatation and warm sterile water irrigation were performed to allow further expansion and fixing of the metal alloy stent around the aortic wall to minimize the duration of aortic cross-clamp. No paravalvular leakage was observed thereafter and the patient was discharged without any complications. Preoperative computed tomography revealed right-sided pleural ￭Case Report￭

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“…Amongst them, sutureless (Perceval; Livanova, London, UK) and rapid-deployment valves (Intuity Valve System; Edwards Lifesciences, Irvine, CA, USA) are successfully used in several settings of conventional and minimally invasive procedures (SUAVR, sutureless aortic valve replacement). They are currently one of the more appealing substitutes for surgeons, who can take advantage of their simplified implantation technique whilst maintaining auxiliary cardiopulmonary bypass and cardioplegic arrest (1,2). On the other hand, transcatheter aortic valves (TAVI) are delivered in a microinvasive fashion (µ-ICS, in a beating and non-assisted heart) (3) and are considered a treatment option primarily for high-risk patients (4,5).…”

Section: Introductionmentioning

confidence: 99%

Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients

D’Onofrio

Fabozzo

Gerosa

2017

Ann. Cardiothorac. Surg.

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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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European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patients

Cited by 151 publications

References 20 publications

Early- and mid-term results of sutureless aortic valve replacement in high-risk patients: our single-center experience

Early- and mid-term results of sutureless aortic valve replacement in high-risk patients: our single-center experience

Intraoperative paravalvular leakage after sutureless aortic valve replacement corrected with secondary balloon dilatation -A case report-

Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients

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