Sutureless aortic valve replacement in multivalve procedures

Szczechowicz, Marcin; Zhigalov, Konstantin; Oßwald, Anja; Eynde, Jef Van den; Rad, Arian Arjomandi; Vardanyan, Robert; Wendt, Daniel; Schmack, Bastian; Ruhparwar, Arjang; Weymann, Alexander

doi:10.21037/jtd-21-300

Cited by 10 publications

(28 citation statements)

References 15 publications

(18 reference statements)

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“…Particular care was taken during the sizing of the Perceval prosthesis in cases of concomitant mitral valve procedures. As previously described, the following was done to avoid technical complications such as left ventricular outflow tract (LVOT) obstruction and mispositioning or migration of the sutureless prosthesis (5). Subsequently, three 3/0 prolene sutures were placed into the nadires of each aortic sinus for the correct positioning of the prepared Perceval prosthesis.…”

Section: Surgical Technique For Su-avrmentioning

confidence: 99%

“…Cardiopulmonary bypass (CPB) time and aortic CC time have been proven to be important independent predictors of mortality in patients undergoing cardiothoracic procedures (4). Thus, approaches enabling a reduction in ischemia-reperfusion injury during cardiothoracic surgical procedures are very desirable, especially in patients with complex infective valvular pathology and multiple comorbidities (5).…”

Section: Introductionmentioning

confidence: 99%

“…Although, successful outcomes for numerous indications have been described after SU-AVR, including multivalve procedures, small annuli and bicuspid aortic valves (5,8,(10)(11)(12), there remains a lack of data originating from large randomized multicenter trials. Therefore, the implementation of sutureless aortic valve prostheses in patients with active infective endocarditis is still considered an off-label procedure and is in fact listed as a contraindication in the product description.…”

Section: Introductionmentioning

confidence: 99%

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Sutureless aortic valve replacement in high-risk patients with active infective endocarditis

Rad¹,

Szczechowicz²,

Ruhparwar³

et al. 2022

J Thorac Dis

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Background: Surgical aortic valve replacement remains the gold standard of treatment in patients with active infective endocarditis. Such procedures tend to carry a significantly higher operative risk when compared to the conventional aortic valve replacement for a non-infective aortic valve disease. Sutureless aortic valve replacement (SU-AVR) has been introduced into cardiac surgery to allow for a simpler implementation of minimally invasive procedures. Although SU-AVR in several extended indications has proven to be successful, the data on the implementation of SU-AVR in patients with infective aortic valve endocarditis remain scarce. The aim of the study was to examine the feasibility of SU-AVR in high-risk patients with active infective aortic valve endocarditis.Methods: Between December 2019 and March 2022, a total of 151 consecutive patients underwent a SU-AVR for various indications at our institution. Of those, in 13 consecutive high-risk patients SU-AVR was indicated because of infective aortic valve endocarditis. In all cases Perceval S aortic valve prosthesis (Corcym, Saluggia, Italy) was used and the implantation has been performed with Snugger-method.Results: The mean age of the patients at operation was 74.05±11.6 years. Eight of the patients suffered from prosthesis endocarditis while the other five patients presented with the endocarditis of the native aortic valve. All patients suffered from multiple comorbidities, as reflected by a mean logistic EuroSCORE of 47.9%±23.1% and EuroSCORE II of 28.7%±22.0%. In 8 patients (61.5%) a concomitant procedure was necessary. Also 8 patients (61.5%) underwent a redo procedure. Bypass-and cross-clamp (CC) times were 89.8±33.6 and 59.1±27.8 minutes, respectively. We observed no paravalvular leakage and no cases of left-ventricular outflow tract obstruction. Postoperative mean gradients after SU-AVR implantation were 8.1±4.8 mmHg.Conclusions: SU-AVR in patients presenting with active infective endocarditis is a safe and feasible surgical alternative to the conventional operation. Clearly, this operative approach should be considered particularly for high-risk patients in whom successful operative outcomes are determined by a reduction in bypass-and CC time. SU-AVR provides excellent hemodynamic performance with a low risk of paravalvular leakage and low transvalvular gradients, whilst simplifying the surgical procedure.

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Section: Surgical Technique For Su-avrmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sutureless aortic valve replacement in high-risk patients with active infective endocarditis

Rad¹,

Szczechowicz²,

Ruhparwar³

et al. 2022

J Thorac Dis

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“…The aortic valve was exposed and excised through an oblique aortotomy. The implantation of sutureless Perceval prostheses was performed using the snugger method as described previously [ 10 , 22 ], and the aortotomy was closed with a 4.0 prolene suture. After assessment of the valve performance and careful de-airing, the patient was weaned from the CPB.…”

Section: Methodsmentioning

confidence: 99%

“…Sutureless aortic valve prostheses have been introduced into cardiac surgery quite a while ago with the aim of reducing the cross-clamp and operating times in patients undergoing combined procedures [ 10 ]. Moreover, the much simpler implantation technique of sutureless prostheses allows for their broad implementation in minimal invasive aortic valve procedures through a J-sternotomy or right antero-lateral thoracotomy access [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath

Szczechowicz

Amanov

Rad

et al. 2022

Life

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Background: The rapid development of transcatheter treatment methods has made transcatheter aortic valve replacement (TAVR) a feasible alternative to conventional surgical aortic valve replacement (SAVR). Recently, indications for TAVR have been expanded to intermediate- and low-risk patients, although there still remains a portion of ineligible patients. We sought to evaluate and compare our experience with sutureless SAVR and transapical TAVR in the “grey-area” of patients unsuitable for transfemoral access. Methods: Between April 2018 and June 2021, 248 consecutive patients underwent a sutureless SAVR (SU-SAVR) or TA-TAVR at our institution. We performed a pair-matched analysis and identified 56 patient pairs based on the EuroSCORE II. All transcatheter procedures were performed using SAPIEN XT/3™ prostheses, while all surgical procedures deployed the Perceval (LivaNova) aortic valve. Results: All patients presented with multiple comorbidities as reflected by the median EuroSCORE-II of 3.1% (IQR 1.9–5.3). Thirty-four patients from the surgical group (60.7%) underwent a concomitant myocardial revascularization. There was no significant difference in major adverse events, pacemaker implantation or postoperative mortality during follow-up. Both interventions demonstrated technical success with similar mean postoperative pressure gradients at follow-up and no cases of paravalvular leakage. Conclusions: Sutureless aortic valve replacement constitutes a feasible treatment alternative for patients with aortic valve disease who are ineligible for transfemoral access route and/or require concomitant coronary revascularization. With its excellent hemodynamic performance, similar survival compared to TA-TAVR, and high cost-efficiency without compromising the postoperative outcomes and in-hospital length of stay SU-AVR might be considered for patients in the “grey-area” between TAVR and SAVR.

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Sutureless aortic valves: The ace up the sleeve of the cardiac surgeon, do we know when to use it?

2022

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Sutureless aortic valve replacement in multivalve procedures

Cited by 10 publications

References 15 publications

Sutureless aortic valve replacement in high-risk patients with active infective endocarditis

Sutureless aortic valve replacement in high-risk patients with active infective endocarditis

Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath

Sutureless aortic valves: The ace up the sleeve of the cardiac surgeon, do we know when to use it?

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