The rise of new technologies for aortic valve stenosis: A comparison of sutureless and transcatheter aortic valve implantation

D’Onofrio, Augusto; Salizzoni, Stefano; Rubino, Antonio; Besola, Laura; Filippini, Claudia; Alfieri, Ottavio; Colombo, Antonio; Agrifoglio, Marco; Fischlein, Theodor; Rapetto, Filippo; Tarantini, Giuseppe; Dalén, Magnus; Gabbieri, Davide; Meuris, Bart; Savini, Carlo; Gatti, Giuseppe; Aiello, Marco; Biancari, Fausto; Livi, Ugolino; Stefàno, Pier Luigi; Cassese, Mauro; Borrello, Bruno; Rinaldi, Mauro; Mignosa, Carmelo; Gerosa, Gino

doi:10.1016/j.jtcvs.2015.11.041

Cited by 43 publications

(61 citation statements)

References 40 publications

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“…When valve performance at rest is concerned, we observed similar results compared with other recently studies, either in terms of peak and mean gradients or in terms of EOA also when compared to a propensity‐matched cohort of patients undergoing TAVI . On the other hand, we observed slightly higher gradients in our multicenter European cohort of patients undergone AVR with Perceval sutureless bioprosthesis compared with a multicenter TAVI Italian experience (ITER registry) . Therefore, a hemodynamic comparison between Perceval sutureless bioprosthesis and TAVI is still a matter of concern and further studies are needed to confirm these results.…”

Section: Discussionsupporting

confidence: 87%

“…demonstrated that small size sutureless valve provided lowest gradients and larger EOA in an in vitro study, compared to two standard pericardial stented bioprostheses. These results have been confirmed clinically by Shresta et al., who observed a mean gradient of 13.6 ± 5.4 cm 2 and an EOA of 1.5 ± 0.25 cm 2 in a cohort of elderly patients with preoperative annulus ≤22 mm. Similarly, Dedeilias et al .…”

Section: Discussionsupporting

confidence: 73%

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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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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 73%

Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

et al. 2017

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“…Therefore, minimally invasive RDV-AVR could prove to be a significant competitor of TAVI, particularly in the high risk patients. In a recent multicenter propensity matched study comparing outcomes of 214 patients matched to either RDV-AVR or TAVI, there was no difference in 30-day or 1-year mortality, stroke, bleeding or myocardial infarction (73). However, the RDV-AVR patients had a higher procedural success rate and less incidence of paravalvular leaks at the cost of higher incidence of pacemaker insertion compared to the TAVI cohort.…”

Section: Sutureless Mini-avr In High Risk Patientsmentioning

confidence: 96%

Minimally invasive aortic valve replacement in high risk patient groups

Fudulu

Lewis

Benedetto³

et al. 2017

J. Thorac. Dis.

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Minimally invasive aortic valve replacement (AVR) aims to preserve the sternal integrity and improve postoperative outcomes. In low risk patients, this technique can be achieved with comparable mortality to the conventional approach and there is evidence of possible reduction in intensive care and hospital length of stay, transfusion requirement, renal dysfunction, improved respiratory function and increased patient satisfaction. In this review, we aim to asses if these benefits can be transferred to the high risk patient groups. We therefore, discuss the available evidence for the following high risk groups: elderly patients, re-operative surgery, poor lung function, pulmonary hypertension, obesity, concomitant procedures and high risk score cohorts.

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“…Moderate or greater PVL in TAVR has been associated with significant mortality , although notably none of our patients developed moderate or greater PVL postprocedurally. While new sutureless aortic valves offer larger effective orifice areas and lower rates of PVL , as future advancements are made in annular sealing technologies, the incidence of PVL after TAVR will likely decline.…”

Section: Discussionmentioning

confidence: 99%

Impact of small prosthesis size on transcatheter or surgical aortic valve replacement outcomes

Salna

Khalique

Chiuzan

et al. 2017

Cathet Cardio Intervent

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The rise of new technologies for aortic valve stenosis: A comparison of sutureless and transcatheter aortic valve implantation

Cited by 43 publications

References 40 publications

Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

Minimally invasive aortic valve replacement in high risk patient groups

Impact of small prosthesis size on transcatheter or surgical aortic valve replacement outcomes

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