Ten years’ experience with the sutureless aortic valve replacement: incidence and predictors for survival and valve durability at follow-up

Pollari, Francesco; Mamdooh, Hazem; Hitzl, Wolfgang; Großmann, I.; Vogt, Ferdinand; Fischlein, Theodor

doi:10.1093/ejcts/ezac572

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…They conclude that younger age at the time of implant is the only factor associated with the risk of longterm structural valve degeneration. 23 In our experience, structural Perceval degeneration occurred in 27 patients (13 size L -9 size M -5 size S) at a mean of 5.6 years (range: 2-9 years). Nineteen of these patients underwent transcatheter valve-in-valve implantation, with a well tolerated, feasible and favourable procedure, and eight patients had surgical sutured valve replacement (Fig.…”

Section: Discussionmentioning

confidence: 68%

“…This could be one of the reasons why the rate of pacemaker implantation is lower in our experience than in the other studies. In a series of 547 patients, Pollari et al 23 analysed risk factors associated with worse survival and bioprosthetic valve failure. They conclude that younger age at the time of implant is the only factor associated with the risk of long-term structural valve degeneration 23 .…”

Section: Discussionmentioning

confidence: 99%

“…In a series of 547 patients, Pollari et al 23 analysed risk factors associated with worse survival and bioprosthetic valve failure. They conclude that younger age at the time of implant is the only factor associated with the risk of long-term structural valve degeneration 23 . In our experience, structural Perceval degeneration occurred in 27 patients (13 size L – 9 size M – 5 size S) at a mean of 5.6 years (range: 2–9 years).…”

Section: Discussionmentioning

confidence: 99%

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Ten-year experience with sutureless Perceval bioprosthesis: single-centre analysis in 1157 implants

Concistrè

Bianchi

Margaryan

et al. 2023

Journal of Cardiovascular Medicine

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Aims We describe long-term clinical and echocardiographic outcomes in the largest single-centre cohort of patients who underwent aortic valve replacement (AVR) with sutureless Perceval (CorCym, Italy) bioprosthesis. Methods Between March 2011 and March 2021, 1157 patients underwent AVR with Perceval bioprosthesis implantation. Mean age was 77 ± 6 years (range: 46–89 years) and mean EuroSCORE II was 6.7 ± 3.2% (range: 1.7–14.2%). Concomitant procedures were performed in 266 patients (23%). Results Thirty-day mortality was 1.38% (16/1157). Eight hundred and twenty of 891 (92%) isolated AVRs underwent minimally invasive surgery with a ministernotomy (n = 196) or right minithoracotomy (n = 624) approach. Cardiopulmonary bypass and aortic cross-clamp times were 81.1 ± 24.3 and 50.6 ± 11.7 min for isolated AVR and 144.5 ± 34.7 and 96.4 ± 21.6 min for combined procedures. At mean follow-up of 53.08 ± 6.7 months (range: 1–120.5 months), survival was 96.5% and mean transvalvular pressure gradient was 13.7 ± 5.8 mmHg. Left ventricular mass decreased from 152.8 to 116.1 g/m2 (P < 0.001) and moderate paravalvular leakage occurred in three patients without haemolysis not requiring any treatment. Freedom from reoperation was 97.6%. Eight patients required surgical reintervention and 19 patients transcatheter valve-in-valve procedure for structural prosthesis degeneration at a mean of 5.6 years after first operation (range: 2–9 years). Conclusion AVR with a Perceval bioprosthesis is associated with good clinical results and excellent haemodynamic performance in our 10-year experience. Structural degeneration rate of Perceval is comparable with other bioprosthetic aortic valves. Sutureless technology may reduce operative time especially in combined procedures and enable minimally invasive AVR.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ten-year experience with sutureless Perceval bioprosthesis: single-centre analysis in 1157 implants

Concistrè

Bianchi

Margaryan

et al. 2023

Journal of Cardiovascular Medicine

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“…Although, in our patient population, in group 1 (Q1), compared to the others, there is a higher percentage of patients in which sutureless prostheses were used, the pacemaker implantation rate was not significantly different from that of the other groups, where less sutureless prostheses were implanted (p for trend 0.687) [19]. However, the superiority of sutureless valves over sutured prostheses has not been proven as of yet [20][21][22]. In 2022, Beretta et al published a PS-matched study [21], in which they assessed the early outcomes of patients undergoing sutureless and rapid deployment aortic valve replacement (SURD-AVR) versus sutured aortic valve replacement (s-AVR) in an all comers real-life registry cohort.…”

mentioning

confidence: 59%

Less Is More? Combined Approaches to Improve Mortality and Morbidity after Aortic Valve Replacement

Mikus,

Fiorentino,

Sangiorgi

et al. 2023

Biomedicines

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Background: Nowadays, one of the main goals of aortic valve surgery is to reduce the biological impact, mortality, and complications. It is well-known that long operative times in terms of the extracorporeal circulation, but above all, of the aortic cross-clamp time (ACC), represent a risk factor for mortality in patients undergoing cardiac surgery. In order to shorten the aortic cross-clamp time, many technological improvements, such as sutureless prostheses, have been introduced, but their actual effectiveness has not been proven yet. The aim of this study was to assess the 30-day outcomes of patients undergoing aortic valve replacement surgery, focusing on the ACC length. Methods: All 3139 patients undergoing aortic valve replacement between January 2013 and July 2022 at our institution were enrolled. The data were retrospectively collected and the baseline characteristics and intraoperative variables were recorded. In order to adjust the results according to the differences in the baseline characteristics, propensity score matching was performed and four groups of 351 patients were obtained based on the first, second, third, and fourth quartile of the ACC time. Results: The patient population included 132 redo surgeries (9.4%) and 61 cases of active endocarditis (4.3%), with an overall median EuroSCORE II of 1.8 (IQR 1.2–3.1). An increase across the groups was observed in terms of the acute kidney failure (p < 0.001) incidence, the number of blood transfusions (p = 0.022), prolonged hospital stays (p < 0.001), the and respiratory failure (p < 0.001) incidence. A p of < 0.1 was found for the 30-day mortality (p = 0.079). The predictors of an early 30-day mortality were standard full sternotomy (OR 2.48, 95% CI 1.14–5.40, p = 0.022), EuroSCORE II (OR 1.10, 95% CI 1.05–1.16, p < 0.001), and a trend for a longer ACC time (Q4 vs. Q1: OR 2.62, 95% CI 0.89–7.68, p = 0.080). Conclusions: Shortening the operative times resulted in marked improvements of the patients’ outcomes. The combined use of minimally invasive approaches and sutureless aortic valve prostheses allows for a lower 30-day events rate. New technologies should be assessed to obtain the best results with the least risk.

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“…This valuable data played a crucial role in the surgeon's decision-making process. Due to the increasing evidence supporting the durability of the rapid deployment valves used, their utilization was unrestricted [12][13][14].…”

Section: Prosthesis Choicementioning

confidence: 99%

Right Anterior versus Right Transaxillary Access for Minimally Invasive Aortic Valve Replacement: A Propensity Matched Competitive Analysis

Taghizadeh-Waghefi,

Arzt,

Wenzel

et al. 2024

JCM

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(1) Background: Right anterior thoracotomy (RAT-AVR) has been the sole established sternum-sparing technique for minimally invasive aortic valve replacement (MICS-AVR) thus far. Nevertheless, transaxillary access, known as Minimally Invasive Cardiac LATeral Surgery (MICLATS-AVR), represents the latest and innovative advancement in sternum-sparing MICS-AVR access routes. In this study, procedural and clinical outcomes of a substantial transaxillary MICS-AVR cohort are compared to those of a RAT-AVR control group; (2) Patients and Methods: This retrospective study included 918 consecutive patients who underwent MICS-AVR at our facility between 2014 and 2022. This cohort was divided into two surgical access-related groups: RAT-AVR (n = 492) and MICLATS-AVR (n = 426). Procedural data, operative morbidity, and mortality were compared between groups. Further analysis was performed using propensity score matching; (3) Results: After matching, 359 pairs of patients were included and analyzed. There were no notable differences observed between the two groups regarding major adverse cardio-cerebral events. Despite longer cardiopulmonary bypass time in the MICLATS-AVR group (63.1 ± 20.4 min vs. 66.4 ± 18.2 min; p ≤ 0.001) the skin-to-skin time (129.4 ± 35.9 min. vs. 126.5 ± 29.8 min.; p = 0.790) and the aortic cross-clamp time was comparable between both groups (41.9 ± 13.3 min. vs. 43.5 ± 14.4 min.; p = 0.182). The overall hospital stay was significantly shorter in the MICLATS-AVR cohort (9.7 ± 5.2 days vs. 9.2 ± 4.5 days; p = 0.01). Both groups were comparable in terms of postoperative morbidities. However, significantly lower rates of postoperative impaired wound healing were noted in the MICLATS-AVR group (11.7% vs. 3.9%, p < 0.001); (4) Conclusions: In comparing MICLATS-AVR and RAT-AVR, our study found MICLATS-AVR to be at least as safe and time-efficient as RAT-AVR, with no significant differences in MACCE. MICLATS-AVR showed a shorter hospital stay and lower postoperative wound issues, indicating its feasibility and safety as an alternative. Notably, MICLATS-AVR is sternum- and bone-sparing, preserving the right mammary artery, and facilitates combined procedures like multiple valve surgeries.

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Ten years’ experience with the sutureless aortic valve replacement: incidence and predictors for survival and valve durability at follow-up

Cited by 8 publications

References 24 publications

Ten-year experience with sutureless Perceval bioprosthesis: single-centre analysis in 1157 implants

Ten-year experience with sutureless Perceval bioprosthesis: single-centre analysis in 1157 implants

Less Is More? Combined Approaches to Improve Mortality and Morbidity after Aortic Valve Replacement

Right Anterior versus Right Transaxillary Access for Minimally Invasive Aortic Valve Replacement: A Propensity Matched Competitive Analysis

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