Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

Rubino, Antonio; Biancari, Fausto; Caruso, Vincenzo; Lavanco, Vincenzo; Privitera, Francesca; Rinaldi, Ivana; Sanfilippo, M.; Millan, Giovanni; D'Urso, Lucia; Castorina, Sergio; Mignosa, Carmelo

doi:10.1111/echo.13735

Cited by 3 publications

(5 citation statements)

References 34 publications

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“…This double sheet of the Perceval could lead to less leaflet mobility, especially at rest, when the stroke volume is not very high. This prosthesis has been shown to dramatically increase its opening during the exercise [ 11 ]. Thus, our findings could change in the presence of high demand for cardiac output.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previous meta-analyses, the lower rate of moderate PPM using the Trifecta could have a benefit in some specific groups such as young patients or those with left ventricular dysfunction. The Perceval aortic prosthesis has shown to dramatically increase its opening during the exercise [ 11 ]. Thus, our findings could change in the presence of high demand for cardiac output.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have evaluated the hemodynamic performance of the Perceval [ 8 , 9 , 10 , 11 ]; even fewer have evaluated the prevalence of PPM using this prosthesis [ 8 ], which is a really important measure for outcomes, and no study has compared the prevalence of this complication with the Trifecta aortic valve.…”

Section: Introductionmentioning

confidence: 99%

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Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch

Hernández-Vaquero

Vigil-Escalera

Persia

et al. 2020

JCM

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The Trifecta aortic valve has excellent hemodynamics characteristics. Moreover, the Perceval prosthesis may achieve better hemodynamics than the conventional valves; therefore, it has been proposed to reduce the incidence of patient–prosthesis mismatch. Our aim was to compare the prevalence of this complication between both prostheses. All patients who underwent valve replacement with a Perceval or a Trifecta from 2016 to 2020 at our institution were included. We calculated the prevalence of patient–prosthesis mismatch for each prosthesis and size and performed a multinomial logistic regression model to investigate the impact of choosing one prosthesis over the other. A total of 516 patients were analyzed. Moderate mismatch was present in 33 (8.6%) in the Trifecta group and 28 (21.4%) in the Perceval group, p < 0.001. Severe mismatch was present in 8 (2.1%) patients with Trifecta and 5 (3.8%) patients with Perceval, p = 0.33. Compared with the Perceval, the Trifecta prosthesis was shown to reduce moderate patient–prosthesis mismatch: OR = 0.5 (95% CI 0.3–0.9, p = 0.02). Both prostheses led to a similar risk of severe patient–prosthesis mismatch: OR = 0.9 (95% CI 0.3–2.8, p = 0.79). Both prostheses provide a very low risk of severe patient–prosthesis mismatch. Compared with the Perceval prothesis, the Trifecta prosthesis is able to reduce by 50% the risk of moderate mismatch.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch

Hernández-Vaquero

Vigil-Escalera

Persia

et al. 2020

JCM

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“…30 Furthermore, Rubino et al showed that under stress, Perceval size S had the highest increase of EOA index at a mean follow-up of 19.5 months, and this benefit was also observed in those patients with severe PPM. 31 Finally, an in vitro study by Tasca et al demonstrated that Perceval shows the greatest EOA when compared with other stented valves on small annuli. 32 These results are probably related to its stentless property.…”

Section: Discussionmentioning

confidence: 99%

Sutureless Valve in Repeated Aortic Valve Replacement: Results from an International Prospective Registry

Glauber

Kent

Asimakopoulos

et al. 2021

Innovations�(Phila)

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Objective To report early and midterm results registry of patients undergoing repeated aortic valve replacement (RAVR) with sutureless prostheses from an international prospective registry (SURE-AVR). Methods Between March 2011 and June 2019, 69 patients underwent RAVR with self-expandable sutureless aortic bioprostheses at 22 international cardiac centers. Results Overall mortality was 2.9% with a predicted logistic EuroSCORE II of 10.7%. Indications for RAVR were structural valve dysfunction (84.1%) and infective prosthetic endocarditis (15.9%) and were performed in patients with previously implanted bioprostheses (79.7%), mechanical valves (15.9%), and transcatheter valves (4.3%). Minimally invasive approach was performed in 15.9% of patients. Rate of stroke was 1.4% and rate of early valve-related reintervention was 1.4%. Overall survival rate at 1 and 5 years was 97% and 91%, respectively. No major paravalvular leak occurred. Rate of pacemaker implantation was 5.8% and 0.9% per patient-year early and at follow-up, respectively. The mean transvalvular gradient at 1-year and 5-year follow-up was 10.5 mm Hg and 11.5 mm Hg with a median effective orifice area of 1.8 cm2and 1.8 cm2, respectively. Conclusions RAVR with sutureless valves is a safe and effective approach and provides excellent clinical and hemodynamic results up to 5 years.

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“…2 As standard AVR is associated with high rates of morbidity in these patients, in the last few years, rapid-deployment aortic valves (RDV) have been developed to facilitate surgical methods, reduce aortic cross-clamping and cardiopulmonary bypass (CPB) time and curtail the risk of mortality and morbidity, and to maintain satisfactory hemodynamic outcomes and low periprosthetic leak rates. 3,4 Several studies confirmed how RDV has been widely used even in off-label indications such as with concomitant mitral valve surgery, 5 surgery for endocarditis, 6 isolated aortic regurgitation 7 and may also be an alternative for high-risk patients. 8 In this study, we compared the mid-term outcomes of rapid-deployment AVR (RD-AVR) with those of the conventional procedure in high-risk surgical patients who underwent isolated AVR or with other cardiac procedures.…”

mentioning

confidence: 96%

Rapid-deployment aortic valve replacement in high-risk patients: A case-control study

Sawadogo

Bui-Duc

D’Ostrevy

et al. 2021

J Cardiovasc Thorac Res

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Introduction: Aortic valve stenosis is the most frequent cardiac valve pathology in the western world. In high-risk patients, conventional aortic valve replacement (C-AVR) carries high rates of morbidity and mortality. In the last few years, rapid-deployment valves (RDV) have been developed to reduce the surgical risks. In this work, we aimed to compare the mid-term outcomes of rapid-deployment AVR (RD-AVR) with those of the C-AVR in high-risk patients. Methods: This retrospective case-control study identified 23 high-risk patients who underwent RD-AVR between 12/2015 to 01/2018. The study group was compared with a control group of 46 patients who were retrospectively selected from a database of 687 C-AVR patients from 2016 to 2017 which matched with the study group for age and Euro SCORE II. Results: RD-AVR group presented more cardiovascular risk factors. Euro SCORE II was higher in the RD-AVR group (P=0.06). In the RD-AVR group, we observed significantly higher mean prosthetic size (P<0.001). In-hospital mortality was zero in RD-AVR group versus 2 deaths in C-AVR group. Hospital stay was longer in the RD-AVR group with statistical significance (P=0.03). In the group AVR with associated cardiac procedures, while comparing subgroups RD-AVR versus C-AVR, early mean gradient was lower in the first cited (P=0.02). The overall mean follow-up was 10.9 ± 4.3 months. Conclusion: The RD-AVR technique is reliable and lead to positive outcomes. This procedure provides a much larger size with certainly better flow through the aortic root. It is an alternative to C-AVR in patients recognized to be surgically fragile.

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Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

Cited by 3 publications

References 34 publications

Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch

Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch

Sutureless Valve in Repeated Aortic Valve Replacement: Results from an International Prospective Registry

Rapid-deployment aortic valve replacement in high-risk patients: A case-control study

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