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Butany J, Schoen FJ. Cardiac valve replacement and related interventions. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kherallah RY, Koneru S, Krajcer Z, Preventza O, Dougherty KG, McCormack ML, Costello BT, Coulter S, Strickman NE, Plana Gomez JC, Mortazavi A, Díez JG, Livesay JJ, Coselli JS, Silva GV. Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience. Ann Cardiothorac Surg 2021; 10:630-640. [PMID: 34733690 DOI: 10.21037/acs-2021-tviv-131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022]
Abstract
Background Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis. Methods We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center. The primary outcome was postprocedural mean aortic valve gradient. Outcomes were compared across surgical valve type (stented versus stentless), surgical valve internal diameter (≤19 versus >19 mm), and transcatheter aortic valve type (self-expanding vs. balloon-expandable). Results Overall, 89 patients underwent ViV-TAVR. Mean age was 69.0±12.6 years, 61% were male, and median Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.4 [interquartile range, 3.2-8.5]. Bioprosthesis mode of failure was stenotic (58% of patients), regurgitant (24%), or mixed (18%). The surgical valve was stented in 75% of patients and stentless in 25%. The surgical valve's internal diameter was ≤19 mm in 45% of cases. A balloon-expandable transcatheter valve was used in 53% of procedures. Baseline aortic valve area and mean gradients were 0.87±0.31 cm2 and 36±18 mmHg, respectively. These improved after ViV-TAVR to 1.38±0.55 cm2 and 18±11 mmHg at a median outpatient follow-up of 331 [67-394] days. Higher postprocedural mean gradients were associated with surgical valves having an internal diameter ≤19 mm (24±13 versus 16±8, P=0.002) and with stented surgical valves (22±11 versus 12±6, P<0.001). Conclusions ViV-TAVR is an effective option for treating degenerated surgical aortic bioprostheses, with acceptable hemodynamic outcomes. Small surgical valves and stented surgical valves are associated with higher postprocedural gradients.
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Affiliation(s)
- R Yazan Kherallah
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Srikanth Koneru
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Kathryn G Dougherty
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Melissa L McCormack
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Briana T Costello
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | | | - Neil E Strickman
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Juan Carlos Plana Gomez
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ali Mortazavi
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Jose G Díez
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James J Livesay
- Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Guilherme V Silva
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Brown JA, Serna-Gallegos D, Kilic A, Dai Y, Chu D, Navid F, Dunn-Lewis C, Sultan I. Midterm Outcomes of Stented Versus Stentless Bioprosthetic Valves After Aortic Root Replacement. Semin Thorac Cardiovasc Surg 2021; 34:1147-1155. [PMID: 34520838 DOI: 10.1053/j.semtcvs.2021.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/11/2022]
Abstract
To determine the impact of aortic root replacement (ARR) with a stentless bioprosthetic valve on midterm outcomes compared to a stented bioprosthetic valve-graft conduit. This was an observational study of aortic root operations from 2010 to 2018. All patients with a complete ARR for nonendocarditis reasons were included, while patients undergoing valve-sparing root replacements or primary aortic valve replacement or repair were excluded. Of the patients with a complete ARR, bioprosthetic valve implants were included, while mechanical valve implants were excluded. Patients were dichotomized into the stented ARR group and the stentless ARR group. A total of 1:1 nearest neighbor propensity matching was employed to assess the association of stentless valves with short-term and midterm outcomes. A total of 455 patients underwent a complete ARR with a bioprosthetic valve implant for nonendocarditis reasons, of which 212 (46.6%) received a stented valve, while 243 (53.4%) received a stentless valve. After matching, postoperative outcomes were similar across each group (P > 0.05), including operative mortality and adverse neurologic events. Median follow-up for the entire cohort was 4.41 years (95% CI: 4.01, 4.95). At 1 year follow-up, aortic regurgitation ≥ 2+ and ejection fraction were similar across each group (P > 0.05); however, the stentless valve group had lower aortic valve velocity and transvalvular pressure gradient. Finally, reoperations and survival were similar for each group over the study's follow-up (P > 0.05). Stentless valves may provide hemodynamic benefits after ARR; however, the clinical impact of those benefits for survival and reoperation may not yet be evident in the midterm.
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Affiliation(s)
- James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yancheng Dai
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Courtenay Dunn-Lewis
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Osswald A, Zubarevich A, Rad AA, Vardanyan R, Zhigalov K, Wendt D, Schmack B, Mashhour A, Ruhparwar A, Weymann A. Geometric changes in aortic root replacement using Freestyle prosthesis. J Cardiothorac Surg 2021; 16:204. [PMID: 34321027 PMCID: PMC8320201 DOI: 10.1186/s13019-021-01583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background The Medtronic Freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation. Methods Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n = 32) and postoperative (n = 10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified. Results Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p < 0.001). Bicuspid valve was present in 28.1% of the patients. Diameter and areas of the aortic root decreased after freestyle implantation, resulting in a reduction of the aortic root volume (45.6 ± 26.3 cm3 to 18.7 ± 4.5 cm3, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p = 0.023). Conclusion Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Preoperative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.
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Affiliation(s)
- Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany.
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Ahmed Mashhour
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany.,Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum Rotenburg an der Fulda, Rotenburg an der Fulda, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
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Vaidya YP, Cavanaugh SM, Sandhu AA. Surgical aortic valve replacement in small aortic annulus. J Card Surg 2021; 36:2502-2509. [PMID: 33821514 DOI: 10.1111/jocs.15555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although aortic valve replacement (AVR) has been the standard of treatment for severe aortic stenosis, a small aortic annulus (SAA) poses significant challenges. Improvements in valve designs and evolution in surgical techniques have led to improved outcomes, however, the ideal prosthetic valve remains elusive. METHODS We performed a comprehensive literature review to discuss the surgical management of aortic stenosis, with a special focus on patients with SAA. RESULTS Stentless valves and root replacement techniques have been shown to overcome the hemodynamic challenges associated with conventional stented bioprostheses, but are technically challenging and require longer cross-clamp times. Sutureless and rapid deployment valves mitigate the long operative time while maintaining the hemodynamic advantages. The use of transcatheter AVR has emerged as another reasonable alternative and has shown promise among patients with SAA, however, long-term outcomes are awaited. CONCLUSION There is no consensus regarding the type of valve prosthesis or replacement technique among patients with SAA. Consideration of patient comorbidities and valvular anatomy is paramount in planning the optimal strategy for AVR. Further long-term clinical trials are necessary to assess outcomes and achieve progress toward the development of the ideal prosthesis.
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Affiliation(s)
- Yash P Vaidya
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Shaelyn M Cavanaugh
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Aqeel A Sandhu
- Department of Cardiothoracic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Van den Eynde J, Sá MPBO, Callahan CP, Dimagli A, Vervoort D, Kampaktsis PN, Zhigalov K, Ruhparwar A, Weymann A. Right ventricular outflow tract reconstruction with Medtronic Freestyle valve in the Ross procedure: A systematic review with meta-analysis. Artif Organs 2020; 45:338-345. [PMID: 33001477 DOI: 10.1111/aor.13837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/01/2022]
Abstract
Cryopreserved pulmonary homografts (PH) are the current gold standard for right ventricular outflow tract (RVOT) reconstruction in the Ross procedure. Unfortunately, their use is limited by a relatively scarce availability and high cost. Porcine stentless xenografts (SX) such as the Medtronic Freestyle SX are increasingly being used, although it is unclear whether the hemodynamic performance and the long-term durability are satisfactory. The present systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. The pooled treatment effects were calculated using a weighted DerSimonian-Laird random-effects model. We also evaluated the effect of time after RVOT reconstruction on valve gradients using meta-regression. Six studies with a total of 156 patients met the inclusion criteria. The pooled estimates for the pooled follow-up of 37 months were: 1.3% operative mortality, 94.8% overall survival, 7.5% structural valve deterioration, 5.2% reintervention, 73.3% asymptomatic, and 1.5% moderate or severe pulmonary insufficiency. Peak valve gradients were significantly correlated with time after RVOT, increasing during follow-up. Three studies compared PH with SX, one concluded that the SX is an acceptable alternative for RVOT reconstruction, whereas two concluded that this valvular substitute had inferior performance. The Freestyle SX can be considered as an alternative to PH, although it might be associated with more reinterventions, higher peak valve pressure gradients, and pulmonary valve dysfunction.
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Affiliation(s)
- Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michel Pompeu B O Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, University of Pernambuco, Recife, Brazil
| | - Connor P Callahan
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Arnaldo Dimagli
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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Aranda-Michel E, Bianco V, Dufendach K, Kilic A, Habertheuer A, Humar R, Navid F, Wang Y, Sultan I. Midterm outcomes of subcoronary stentless porcine valve versus stented aortic valve replacement. J Card Surg 2020; 35:2950-2956. [PMID: 32789931 DOI: 10.1111/jocs.14943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Stentless porcine xenografts are versatile bioprosthetic valves with the advantage of improved hemodynamics that mimic the function of the native aortic valve. However, these bioprostheses are challenging to implant in the subcoronary position. METHODS All consecutive patients who underwent a bioprosthetic aortic valve replacement (AVR) were included from our institutional database. Cox regression analysis was preformed to determine significant predictors for mid term mortality as well as all cause, cardiac, and heart failure readmission. RESULTS Patients in the subcoronary stentless group were older and more likely to be female and were likely to have a higher Society of Thoracic Surgery risk of mortality. Survival was superior in the stented AVR cohort at 30-days (96.4% vs 90.5%; P < .001), 1-year (90.5% vs 71.6%; P < .001), and 5-year (74.5% vs 56.9%; P < .001) follow up. Acute kidney injury (16.22% vs 5.22%; P < .001) and blood product transfusion (70.27% vs 44.0%; P < .001) were higher in the stentless group. Multivariable analysis revealed subcoronary stentless implantation as a significant independent risk factor for mortality (hazards ratio: 1.92 [1.35,2.72]; P < .001). CONCLUSION Stentless porcine xenograft implantation with the Freestyle bioprosthetic in the subcoronary position can be successfully performed in select patients, but its use is associated with increased perioperative morbidity and mortality affecting midterm outcomes. Individual patient selection and surgeon experience are important to ensure favorable outcomes.
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Affiliation(s)
- Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Keith Dufendach
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andreas Habertheuer
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rishab Humar
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Stefanelli G, Pirro F, Smorto V, Bellisario A, Chiurlia E, Weltert L. Stentless Pericarbon Freedom Versus Stented Perimount Aortic Bioprosthesis: Propensity-Matched Long-Term Follow-Up. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:440-448. [PMID: 32628077 DOI: 10.1177/1556984520929778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Stentless aortic valves have shown superior hemodynamic performance and faster left ventricular mass regression compared to stented bioprostheses. Yet, controversies exist concerning the durability of stentless valves. This case-matched study compared short- and long-term clinical outcomes of stentless LivaNova-Sorin Pericarbon Freedom™ (SPF) and stented Carpentier-Edwards Perimount (CEP) aortic prostheses. METHODS From 2003 through 2006, 134 consecutive patients received aortic valve replacement with SPF at our institution. This cohort was matched, according to 20 preoperative clinical parameters, with a control group of 390 patients who received CEP prosthesis during the same time. The resulting 55 + 55 matched patients were analyzed for perioperative results and long-term clinical outcomes. RESULTS Early mortality was 0% for both groups. Lower transvalvular gradients were found in the SPF group (10.6 ± 2.9 versus 15.7 ± 3.1 mmHg, P < 0.001). Overall late mortality (mean follow-up: 10.03 years) was similar for both groups (50.1% versus 42.8%, P = 0.96). Freedom from structural valve degeneration (SVD) at 13 years was similar for both groups (SPF = 92.3%, CEP = 73.9%, P = 0.06). Freedom from aortic valve reinterventions did not differ (SPF = 92.3%, CEP = 93.5%, P = 0.55). Gradients at 13-year follow-up remained significantly lower in SPF group (10.0 ± 4.5 versus 16.2 ± 9.5 mmHg, P < 0.001). Incidence of acute bacterial endocarditis (ABE) and major adverse cardiovascular and cerebrovascular events (MACCE) was similar. CONCLUSIONS SPF and CEP demonstrated comparable long-term outcomes related to late mortality, SVD, aortic valve reinterventions, and incidence of ABE and MACCE. Superior hemodynamic performance of SPF over time can make this valve a suitable choice in patients with small aortic root and large body surface area.
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Affiliation(s)
- Guglielmo Stefanelli
- 18614 Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Fabrizio Pirro
- 18614 Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Vincenzo Smorto
- 18614 Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Alessandro Bellisario
- European Hospital, Rome, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Emilio Chiurlia
- 18614 Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Luca Weltert
- European Hospital, Rome, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy
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Weymann A, Zhigalov K, Bisleri G. Balloon-Expandable Rapid-Deployment Valve Implantation for Small Aortic Root. Ann Thorac Surg 2020; 111:379. [PMID: 32525028 DOI: 10.1016/j.athoracsur.2020.04.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander Weymann
- Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Konstantin Zhigalov
- Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Hufelandstr 55, 45147 Essen, Germany.
| | - Gianluigi Bisleri
- Cardiac Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Puluca N, Münsterer A, Prinzing A, Sexton ZA, Lange R, Meyer-Saraei R, Scharfschwerdt M. In vitro comparison of everting vs. non-everting suture techniques for the implantation of a supra-annular biological heart valve. J Thorac Dis 2020; 12:2443-2449. [PMID: 32642150 PMCID: PMC7330396 DOI: 10.21037/jtd.2020.03.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/05/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the hemodynamic effect of different suturing techniques for aortic valve replacement (AVR) in vitro. Whether or not the applied suturing technique impacts the outflow tract diameter by narrowing the annulus diameter was examined. METHODS The commonly applied non-everting pledget forced suture technique (NE, n=13) was compared with an everting pledget forced suture (ET, n=13) for AVR using the 25 mm St. Jude Trifecta aortic valve. Hemodynamic parameters were obtained in a pulsatile flow simulator. A high speed camera captured the visual aspects of the suturing technique. RESULTS Despite some kind of left ventricular outflow narrowing due to protruding pledgets using the NE suture technique, mean pressure gradients of both techniques were nearly similar (NE 5.88±2.7 mmHg, ET 5.23±1.31 mmHg, P=0.44). Closing volume (NE 3.16±0.48 mL; ET 3.51±0.68 mL; P=0.14) and the leakage volume (NE: 8.09±2.53 mL; ET: 8.35±3.65 mL; P=0.83) also showed no differences. CONCLUSIONS AVR using either suturing techniques leads to a similar hemodynamic performance in vitro. The impact of the suturing technique may be higher in a smaller annulus. Therefore, further studies using smaller prostheses are necessary.
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Affiliation(s)
- Nazan Puluca
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany
- Insure (Institute for Translational Cardiac Surgery) Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany
| | - Andrea Münsterer
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany
- Insure (Institute for Translational Cardiac Surgery) Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany
| | - Anatol Prinzing
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany
- Insure (Institute for Translational Cardiac Surgery) Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany
| | - Zachary A. Sexton
- Division of Cardiovascular Medicine, Department of Medicine; Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany
- Insure (Institute for Translational Cardiac Surgery) Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany
- German Heart Center Munich-DZHK Partner Site Munich Heart Alliance, Munich, Germany
| | - Roza Meyer-Saraei
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
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Outcomes Following Transcatheter Aortic Valve Replacement for Degenerative Stentless Versus Stented Bioprostheses. JACC Cardiovasc Interv 2019; 12:1256-1263. [DOI: 10.1016/j.jcin.2019.02.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 11/23/2022]
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Freitas-Ferraz AB, Tirado-Conte G, Dagenais F, Ruel M, Al-Atassi T, Dumont E, Mohammadi S, Bernier M, Pibarot P, Rodés-Cabau J. Aortic Stenosis and Small Aortic Annulus. Circulation 2019; 139:2685-2702. [DOI: 10.1161/circulationaha.118.038408] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Afonso B. Freitas-Ferraz
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Gabriela Tirado-Conte
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Francois Dagenais
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Marc Ruel
- University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R., T.A.-A.)
| | - Talal Al-Atassi
- University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R., T.A.-A.)
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Mathieu Bernier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
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Easo J, Weymann A, Hölzl P, Horst M, Eichstaedt H, Mashhour A, Zhigalov K, Szczechowicz M, Thomas RP, Sabashnikov A, Dapunt OE. Hospital Results of a Single Center Database for Stentless Xenograft Use in a Full Root Technique in Over 970 Patients. Sci Rep 2019; 9:4371. [PMID: 30867492 PMCID: PMC6416277 DOI: 10.1038/s41598-019-40772-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/19/2019] [Indexed: 12/01/2022] Open
Abstract
Our aim was to analyse the hospital outcome for the worldwide largest series of stentless bioroot xenografts (Medtronic Freestyle) as full root replacement in a single centre over a period of 18 years. Retrospective data analysis was performed for the entire cohort of patients undergoing aortic root surgery with the Medtronic Freestyle valve prosthesis. Logistic regression analysis was performed to analyse predictors of in-hospital mortality. 971 patients underwent aortic full root replacement with the Medtronic Freestyle valve in the period from 1999–2017, with an average age of 68.8 ± 10.3y and gender distribution of 608:363 (male:female). Concomitant surgery was performed in 693 patients (71.4%). In-hospital all-comers mortality was 9.8% (95 patients), with the respective highest risk profiles including dissections (6.4%), endocarditis (5.6%) and re-do procedures (12.5%). In-hospital mortality for elective patients was 7.6% while isolated aortic root replacement demonstrated a mortality of 3.6%. Logistic regression analysis demonstrated age (OR 1.05, p = 0.005), dissection (OR 5.78, p < 0.001) and concomitant bypass surgery (OR 2.68, p < 0.001) as preoperative risk factors for the entire cohort. Postoperative analysis demonstrated myocardial infarction (OR 48.6, p < 0.001) and acute kidney injury (OR 20.2, p < 0.001) to be independent risk factors influencing mortality. This analysis presents a work-through of all patients with stentless bioroot treatment without positive selection in a high-volume clinical center with the largest experience world-wide for this form of complex surgery. Isolated aortic root replacement could be performed at acceptable operative risk for this technically-challenging procedure.
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Affiliation(s)
- Jerry Easo
- Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Rahel-Straus Str 10, 26133, Oldenburg, Germany.
| | - Alexander Weymann
- Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Rahel-Straus Str 10, 26133, Oldenburg, Germany
| | - Philipp Hölzl
- Department of Cardiac and Thoracic Surgery HELIOS Hospital Siegburg, Ring Str. 49, 53721, Siegburg, Germany
| | - Michael Horst
- Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Rahel-Straus Str 10, 26133, Oldenburg, Germany
| | - Harald Eichstaedt
- Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Rahel-Straus Str 10, 26133, Oldenburg, Germany
| | - Ahmed Mashhour
- Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Rahel-Straus Str 10, 26133, Oldenburg, Germany
| | - Konstantin Zhigalov
- Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Rahel-Straus Str 10, 26133, Oldenburg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Rahel-Straus Str 10, 26133, Oldenburg, Germany
| | - Rohit Philip Thomas
- Department of Diagnostic and Interventional Radiology, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Rahel-Straus Str 10, 26133, Oldenburg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Otto E Dapunt
- Division of Cardiac Surgery, Medical University of Graz, Auenbrugger Platz 29, 8036, Graz, Austria
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Watanabe Y, Naganuma T, Kitanaka Y, Nakamura S. Thromboembolic acute myocardial infarction after aortic valve replacement using the Freestyle stentless aortic bioprosthesis with subcoronary valve replacement. Eur J Cardiothorac Surg 2019; 55:587-589. [PMID: 30107540 DOI: 10.1093/ejcts/ezy283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 11/12/2022] Open
Abstract
A 70-year-old woman with substernal chest pain lasting 2.5 h presented to the emergency department of our hospital. She had a history of aortic valve replacement with the Freestyle stentless aortic bioprosthesis for severe aortic regurgitation 7 years ago. The initial electrocardiogram showed sinus rhythm at a rate of 71 bpm with ST-segment slight elevation in leads II, III and aVF. She was diagnosed as having acute coronary syndrome and was referred for an urgent catheterization. Urgent coronary angiography revealed total occlusion in the distal segment of the right coronary artery. Furthermore, a cavity was revealed around the aortic annulus by the contrast leaked from the ostium of the right coronary artery during angiography. Contrast-enhanced computed tomography showed an enhanced cavity between the native aortic wall and the bioprosthesis and the defect in the cavity. We diagnosed the incompetence of the bioprosthesis and decided to perform repeat aortic valve replacement. During surgery, the presence of a thrombus was confirmed in the cavity. The finding indicated that this embolic event was due to the thrombus from the cavity.
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Affiliation(s)
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Yosuke Kitanaka
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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Stented versus Stentless Aortic Valve Replacement in Patients with Small Aortic Root. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:404-416. [DOI: 10.1097/imi.0000000000000569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The aim of the study was to compare hemodynamic and perioperative outcomes of stented against stentless aortic valve replacement in patients with small aortic root (21 mm or less). Methods A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing stentless to stented bioprosthetic valves in small aortic root patients. Odds ratios, weighted mean differences, or standardized mean differences and their 95% confidence intervals were analyzed. Results A total of seven studies with a total of 965 patients fulfilled the inclusion criteria. There was no significant difference in preoperative baselines including mean age between both groups ( P = 0.08), peak aortic valve gradient ( P = 0.06), and effective orifice area ( P = 0.28), whereas higher mean aortic valve gradient in the stented group ( P = 0.007). No difference in cardiopulmonary bypass time ( P = 0.74), aortic cross-clamp times ( P = 0.88), intensive care unit stay ( P = 0.13), and stroke rate ( P = 0.56) were noted. However, stented group of patients showed higher rate of patient prosthesis mismatch ( P = 0.0001) and longer total hospital stay ( P = 0.002). Postoperatively, stentless group showed lower peak and mean aortic valve gradient ( P = 0.003 and P = 0.008, respectively) with a better effective orifice area ( P < 0.00001) at 6 months of follow-up. Mortality rates while in-hospital and at 1 year were similar in both groups ( P = 0.94 and P = 0.86, respectively). Conclusions Stentless aortic valves offer superior short-term hemodynamic outcomes in patients with small aortic root when compared with stented aortic valves. Although both groups have similar perioperative complications rates, stentless valves bring about a shorter hospital stay. A further large multicenter randomized controlled trial should address the longer-term benefit of stentless aortic valve over stented valve.
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Correia PM. The place of a stentless aortic bioprosthetic valve. Rev Port Cardiol 2018; 37:819-820. [PMID: 30318189 DOI: 10.1016/j.repc.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pedro M Correia
- Centro de Cirurgia Cardiotorácica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
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The place of a stentless aortic bioprosthetic valve. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Stefanelli G, Pirro F, Olaru A, Danniballe G, Labia C, Weltert L. Long-term outcomes using the stentless LivaNova-Sorin Pericarbon Freedom™ valve after aortic valve replacement†. Interact Cardiovasc Thorac Surg 2018; 27:116-123. [DOI: 10.1093/icvts/ivy012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/07/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Fabrizio Pirro
- Department of Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Alina Olaru
- Department of Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | | | - Clorinda Labia
- Department of Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | - Luca Weltert
- Department of Cardiac Surgery, European Hospital, Rome, Italy
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Wollersheim LW, Li WW, Kaya A, Bouma BJ, Driessen AH, van Boven WJ, van der Meulen J, de Mol BA. Stentless vs Stented Aortic Valve Bioprostheses in the Small Aortic Root. Semin Thorac Cardiovasc Surg 2016; 28:390-397. [DOI: 10.1053/j.semtcvs.2016.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 11/11/2022]
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Heimansohn D, Roselli EE, Thourani VH, Wang S, Voisine P, Ye J, Dabir R, Moon M. North American trial results at 1 year with the Sorin Freedom SOLO pericardial aortic valve. Eur J Cardiothorac Surg 2015; 49:493-9; discussion 499. [PMID: 26003957 DOI: 10.1093/ejcts/ezv169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 03/25/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES A North American prospective, 15-centre Food and Drug Administration (FDA) valve trial was designed to assess the safety and effectiveness of the Freedom SOLO stentless pericardial aortic valve in the treatment of surgical aortic valve disease. METHODS Beginning in 2010, 251 patients (mean: 74.7 ± 7.5 years), were recruited in the Freedom SOLO aortic valve trial. One hundred eighty-nine patients have been followed for at least 1 year and are the basis for this review. Preoperatively, 54% of patients had NYHA functional class III or IV symptoms, and the majority of patients had a normal ejection fraction (EF) (median EF = 61%). Concomitant procedures were performed in 61.9% of patients, with coronary artery bypass grafting (CABG) (48.7%) being the most common followed by a MAZE procedure (13.7%). Reoperations were performed in 8.5% of patients in the study. RESULTS The entire cohort of 251 patients enrolled had 7 deaths prior to 30 days, 2 of which were valve-related (aspiration pneumonia and sudden death) and 5 were not valve-related. There were 11 deaths after 30 days, 1 valve-related (unknown cardiac death) and 10 not valve-related. Five valves were explanted, 3 early (endocarditis, acute insufficiency and possible root dissection) and 2 late (endocarditis). Thirty-day adverse events include arrhythmias requiring permanent pacemaker (4.2%), thromboembolic events (3.7%) and thrombocytopenia (7.4%). One-year follow-up of all 189 patients demonstrated mean gradients for valve sizes 19, 21, 23, 25 and 27 mm of 11.7, 7.8, 6.3, 4.6 and 5.0 mmHg, respectively. Effective orifice areas for the same valve sizes were 1.2, 1.3, 1.6, 1.8 and 1.9 cm(2), respectively. Ninety-six percent of patients (181/189) were in NYHA class I or II at the 1-year follow-up. CONCLUSIONS The Freedom SOLO stentless pericardial aortic valve demonstrated excellent haemodynamics and a good safety profile out to the 1 year of follow-up.
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Affiliation(s)
- David Heimansohn
- Department of Cardiothoracic Surgery, St Vincent Heart Center, Indianapolis, IN, USA
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
| | - Shaohua Wang
- Department of Cardiothoracic Surgery, University of Alberta, Edmonton, AB, USA
| | | | - Jian Ye
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Reza Dabir
- Great Lakes Cardiovascular and Thoracic Surgeons, Dearborn, MI, USA
| | - Michael Moon
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
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Long-term results of Freestyle stentless bioprosthesis in the aortic position: A single-center prospective cohort of 500 patients. J Thorac Cardiovasc Surg 2014; 148:1903-11. [DOI: 10.1016/j.jtcvs.2014.02.063] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 01/06/2014] [Accepted: 02/20/2014] [Indexed: 11/24/2022]
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Yadlapati A, Diep J, Barnes M, Grogan T, Bethencourt DM, Vorobiof G. Comprehensive Hemodynamic Comparison and Frequency of Patient-Prosthesis Mismatch between the St. Jude Medical Trifecta and Epic Bioprosthetic Aortic Valves. J Am Soc Echocardiogr 2014; 27:581-9. [DOI: 10.1016/j.echo.2014.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Indexed: 11/28/2022]
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Forcillo J, El Hamamsy I, Stevens LM, Badrudin D, Pellerin M, Perrault LP, Cartier R, Bouchard D, Carrier M, Demers P. The Perimount Valve in the Aortic Position: Twenty-Year Experience With Patients Under 60 Years Old. Ann Thorac Surg 2014; 97:1526-32. [DOI: 10.1016/j.athoracsur.2014.02.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 01/20/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
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Long-Term Clinical Outcomes 15 Years After Aortic Valve Replacement With the Freestyle Stentless Aortic Bioprosthesis. Ann Thorac Surg 2014; 97:544-51. [DOI: 10.1016/j.athoracsur.2013.08.047] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 11/19/2022]
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Sansone F, Dato GMA, Zingarelli E, Ferrero E, Prot S, Ceresa F, Patanè F, Casabona R. Long-term follow-up of stentless prosthesis. J Cardiol 2013; 63:365-72. [PMID: 24216316 DOI: 10.1016/j.jjcc.2013.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/11/2013] [Accepted: 09/13/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stentless prostheses have an interesting hemodynamic performance when compared to stented prostheses and are recommended in cases of small aortic annulus. MATERIALS AND METHODS From January 1996 to January 2004, 138 patients suffering from aortic disease, underwent aortic valve replacement. • Group A: 93 patients underwent stentless aortic valve implantation [stentless Biocor (Biocor Industria e Pesguisa Ltda, Belo Horizonte, Brazil) and stentless Sorin (Sorin Group, Saluggia, Italy)]. • Group B: 45 patients underwent stented aortic valve implantation (stented Biocor). Patients were assessed by clinical evaluation and echocardiography after a mean follow up of 124.5 ± 58.2 months. RESULTS There was a significant difference in terms of time of extracorporeal circulation and aortic cross clamp. The actuarial survival at 4, 8, 12, and 15 years is 77%, 50%, 21%, and 18%, respectively. Freedom from reoperation at 4, 8, 12, and 14 years was 92%, 83%, 73%, and 63%, respectively. Freedom from all events, death, and reoperation at 4, 8, 12, and 14 years was 70%, 39%, 13%, and 8%, respectively. There is no statistical difference among the two groups in terms of actuarial survival, freedom from reoperation, and freedom from re-hospitalization for prosthesis-related causes. DISCUSSION There was a significantly higher incidence of pacemaker implantation in Group A and the causes are not known. The rate of freedom from reoperation is high in both groups for the patients who remained alive. There was no statistical difference about prosthesis dysfunction between the two groups. The higher incidence of death in Group A cannot be explained by causes related to the prosthesis because there is no difference in terms of causes of death. Rates of reoperation did not differ between the two groups. CONCLUSIONS The results obtained with stentless prostheses are encouraging even in long-term follow-up.
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Affiliation(s)
- Fabrizio Sansone
- Division of Cardiac Surgery, Mauriziano Umberto I Hospital, L. go Turati 62, 10135 Turin, Italy.
| | | | - Edoardo Zingarelli
- Division of Cardiac Surgery, Mauriziano Umberto I Hospital, L. go Turati 62, 10135 Turin, Italy
| | - Emanuele Ferrero
- Division of Cardiac Surgery, Mauriziano Umberto I Hospital, L. go Turati 62, 10135 Turin, Italy
| | - Sara Prot
- Division of Cardiac Surgery, Mauriziano Umberto I Hospital, L. go Turati 62, 10135 Turin, Italy
| | - Fabrizio Ceresa
- Division of Cardiac Surgery, Mauriziano Umberto I Hospital, L. go Turati 62, 10135 Turin, Italy
| | - Francesco Patanè
- Division of Cardiac Surgery, Mauriziano Umberto I Hospital, L. go Turati 62, 10135 Turin, Italy
| | - Riccardo Casabona
- Division of Cardiac Surgery, Mauriziano Umberto I Hospital, L. go Turati 62, 10135 Turin, Italy
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Tully PJ, Aty W, Rice GD, Bennetts JS, Knight JL, Baker RA. Aortic Valve Prosthesis–Patient Mismatch and Long-Term Outcomes: 19-Year Single-Center Experience. Ann Thorac Surg 2013; 96:844-50. [DOI: 10.1016/j.athoracsur.2013.04.075] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 12/01/2022]
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Christ T, Grubitzsch H, Claus B, Konertz W. Stentless aortic valve replacement in the young patient: long-term results. J Cardiothorac Surg 2013; 8:68. [PMID: 23566631 PMCID: PMC3639088 DOI: 10.1186/1749-8090-8-68] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/22/2013] [Indexed: 12/02/2022] Open
Abstract
Background Stentless aortic valve replacement (SAVR) became a common surgical procedure to treat aortic valve disease, as it offers larger orifice area and improved hemodynamics. The aim of our single-centre retrospective study was to assess long term results of first generation stentless aortic valves in young patients, where mechanical prostheses are considered first line therapy. Methods From 1993 to 2001, 188 (149 male and 39 female) patients (≤60 years) underwent SAVR. Indications were in 63.3% stenosis or mixed lesions and in 36.7% isolated regurgitation. Mean age of patients at surgery was 53.1 ± 7.1 years. Associated procedures were performed in 60 patients (31.9%). Follow-up data were acquired through telephone interviews. Follow-up was 90.4% complete at a mean of 8.8 ± 4.7 years. Total follow-up was 1657.6 patient-years with a maximum of 17 years. Results Overall hospital mortality was 3.2% (2.5% for isolated SAVR). Overall actuarial survival-rate at 10/15 years and freedom from reoperation at 10/14 years were 73.0% ± 3.5%/ 55.8% ± 5.4% and 81.0% ± 3.4%/ 58.0% ± 7.5%, respectively. For isolated SAVR, actuarial survival at 10/15 years and freedom from reoperation at 10/14 years were 70.1% ± 4.4%/ 64.1% ± 4.8% and 83.1% ± 4.0%/ 52.9% ± 9.0%, respectively. Reoperation was performed in 42 patients (22.3%) due to structural valve deterioration and endocarditis. Age (≤50 years) and associated procedures did not significantly lower survival and freedom from reoperation, however, small prosthesis sizes (≤25 mm) did. Conclusion In patients aged 60 and younger, SAVR provides reliable long-term results especially for larger aortic valves.
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Christ T, Grubitzsch H, Claus B, Konertz W. Long-term follow-up after aortic valve replacement with Edwards Prima Plus stentless bioprostheses in patients younger than 60 years of age. J Thorac Cardiovasc Surg 2012; 147:264-9. [PMID: 23158257 DOI: 10.1016/j.jtcvs.2012.10.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 09/25/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The Edwards Prima Plus was one of the first stentless aortic valve bioprostheses, with larger orifice areas and improved hemodynamics compared to stented bioprostheses. The aim of the present single-center retrospective study was to assess the long-term results of the Edwards Prima Plus in patients 60 years old or younger. METHODS From 1993 to 2001, 120 patients (99 men and 21 women) aged 60 years or younger underwent implantation of the Edwards Prima Plus. The indications were stenosis and/or insufficiency. Associated procedures were performed in 38 patients (31.7%). Of the patients, 39% had impaired left ventricular function. Follow-up data were acquired by telephone interview. Time-to event analyses were performed using the Kaplan-Meier method. Variables affecting survival and freedom from reoperation were evaluated using Cox regression analysis. The mean patient age at surgery was 53.1 ± 8.0 years. The follow-up data were 88.8% complete at a mean of 8.5 ± 4.5 years. The total follow-up was 1022.7 patient-years. RESULTS At 10 and 15 years, the overall actuarial survival rate was 71.8% ± 4.4% and 48.8% ± 9.6%, respectively. Survival was significantly lower for patients with older age, aortic insufficiency as the surgical indication, and small prosthesis size (≤25 mm vs ≥27 mm). Reoperation was performed in 20 patients (16.7%), with a hospital mortality of 5%. At 10 and 14 years, the overall freedom from reoperation rate was 85.6% ± 3.7% and 65.2% ± 8.6%, respectively. Freedom from reoperation was significantly lower in patients with a small prosthesis size (≤25 mm) and insufficiency as the indication for surgery. CONCLUSIONS In patients aged 60 years or younger, an Edwards Prima Plus can provide reliable long-term results with acceptable freedom-from-reoperation rates.
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Affiliation(s)
- Torsten Christ
- Clinic for Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Herko Grubitzsch
- Clinic for Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Claus
- Clinic for Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Konertz
- Clinic for Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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VanderLaan PA, Padera RF, Schoen FJ. Practical Approach to the Evaluation of Prosthetic Mechanical and Tissue Replacement Heart Valves. Surg Pathol Clin 2012; 5:353-69. [PMID: 26838108 DOI: 10.1016/j.path.2012.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mechanical and bioprosthetic substitute heart valves have dramatically improved life expectancy and quality of life in patients with valvular heart disease. Complications of substitute heart valves are a relatively infrequent occurrence, often due to thrombosis, infection, or structural/mechanical failure. It is important to accurately identify and systematically evaluate prosthetic heart valves when encountered as surgical pathology specimens or in the autopsy setting.
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Affiliation(s)
- Paul A VanderLaan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Borger MA, Lehmann S, Seeburger J, Mohr FW. The Demise of the Stentless Valve. Semin Thorac Cardiovasc Surg 2012; 24:5-7. [DOI: 10.1053/j.semtcvs.2012.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2012] [Indexed: 11/11/2022]
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Funder JA. Current status on stentless aortic bioprosthesis: a clinical and experimental perspective. Eur J Cardiothorac Surg 2011; 41:790-9. [DOI: 10.1093/ejcts/ezr141] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bergsland J. Safe introduction and quality control of new methods in coronary surgery. Acta Inform Med 2011; 19:203-15. [PMID: 23408734 PMCID: PMC3564183 DOI: 10.5455/aim.2011.19.203-215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 12/25/2011] [Indexed: 11/04/2022] Open
Abstract
Introduction: The first part of the paper analyses off pump coronary bypass surgery (OPCAB), which is compared with traditional on-pump procedures (ONCAB). Furthermore ,the paper evaluates the use of a new automatic device for performance of the proximal anastomosis and finally the effect of intracoronary shunt on myocardial ischemia during OPCAB. The main goal of the paper is to demonstrate the importance of careful clinical studies during introduction of the new techniques in cardiac surgery. Methods: Statistical analysis was performed on a large clinical database from Buffalo, NY, USA comparing OPCAB and ONCAB. Subsequently, a sequential controlled clinical study compared patients operated with a new automatic connector device to patients operated with classic suture technique. Finally a randomized study was performed to evaluate the effect of the use of an intracoronary shunt during construction of distal anastomosis. Results: The studies from Buffalo demonstrated reduced complications rates in high risk patients when OPCAB techniques were used. The use of connector devices in saphenous venous anastomosis was clearly inferior to standard technique. Intracoronary shunt was found to be beneficial by preventing ischemia. Discussion: Numerous studies have studied the results of OPCAB vs ONCAB and although results are variable it seems that OPCAB is advantageous in high risk patients, while in low risk patients there are much less if any benefit. The results of the studies of connector devices caused the product to be taken off the market. The value of shunt in OPCAB was clearly demonstrated by the randomized studies. Conclusion: The investigations presented in this paper clearly demonstrates the importance of well-designed studies when new surgical methods are introduced. In the present period of rapid technological development, carefully controlled, un-biased clinical trials are crucial to preserve patient safety and avoid unjustified societal cost.
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Affiliation(s)
- Jacob Bergsland
- The Interventional Centre, Oslo University Hospital, Oslo, Norway ; BH Heart Centre, Tuzla, Bosnia and Herzegovina
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Piazza N, Bleiziffer S, Brockmann G, Hendrick R, Deutsch MA, Opitz A, Mazzitelli D, Tassani-Prell P, Schreiber C, Lange R. Transcatheter Aortic Valve Implantation for Failing Surgical Aortic Bioprosthetic Valve. JACC Cardiovasc Interv 2011; 4:721-32. [DOI: 10.1016/j.jcin.2011.03.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 03/24/2011] [Accepted: 03/31/2011] [Indexed: 10/18/2022]
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Abstract
Although porcine aortic valves or pericardial tissue mounted on a stent have made implantation techniques easier, these valves sacrifice orifice area and increase stress at the attachment of the stent, which causes primary tissue failure. Optimizing hemodynamics to prevent patient–prosthetic mismatch and improve durability, stentless bioprostheses use was revived in the early 1990s. The purpose of this review is to provide a current overview of stentless valves in the aortic position. Retrospective and prospective randomized controlled studies showed similar operative mortality and morbidity in stented and stentless aortic valve replacement (AVR), though stentless AVR required longer cross-clamp and cardiopulmonary bypass time. Several cohort studies showed improved survival after stentless AVR, probably due to better hemodynamic performance and earlier left ventricular (LV) mass regression compared with stented AVR. However, there was a bias of operation age and nonrandomization. A randomized trial supported an improved 8-year survival of patients with the Freestyle or Toronto valves compared with Carpentier–Edwards porcine valves. On the contrary, another randomized study did not show improved clinical outcomes up to 12 years. Freedom from reoperation at 12 years in Toronto stentless porcine valves ranged from 69% to 75%, which is much lower than for Carpentier–Edwards Perimount valves. Cusp tear with consequent aortic regurgitation was the most common cause of structural valve deterioration. Cryolife O’Brien valves also have shorter durability compared with stent valves. Actuarial freedom from reoperation was 44% at 10 years. Early prosthetic valve failure was also reported in patients who underwent root replacement with Shelhigh stentless composite grafts. There was no level I or IIa evidence of more effective orifice area, mean pressure gradient, LV mass regression, surgical risk, durability, and late outcomes in stentless bioprostheses. There is no general recommendation to prefer stentless bioprostheses in all patients. For new-generation pericardial stentless valves, follow-up over 15 years is necessary to compare the excellent results of stented valves such as the Carpentier–Edwards Perimount and Hancock II valves.
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Affiliation(s)
- Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
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Chan KMJ, Rahman-Haley S, Mittal TK, Gavino JA, Dreyfus GD. Truly stentless autologous pericardial aortic valve replacement: an alternative to standard aortic valve replacement. J Thorac Cardiovasc Surg 2010; 141:276-83. [PMID: 20965520 DOI: 10.1016/j.jtcvs.2010.09.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 09/08/2010] [Accepted: 09/24/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to determine the feasibility and durability of truly stentless aortic valve replacement using autologous pericardium sutured directly onto the aortic wall. METHODS Eleven patients (mean age, 55.9 years) requiring aortic valve replacement were recruited. A circular piece of pericardium about 8 cm in diameter was harvested and treated in 0.6% glutaraldehyde for 10 minutes. The aortic valve was excised and, with the use of specially designed instruments (CardioMend LLC, Santa Barbara, Calif), the sinotubular junction was sized and the pericardium was tailored to the required size and shape and then sutured directly onto the aortic wall. The reconstructed valve was assessed directly and by echocardiography at the end of the operation; it was assessed by echocardiography and cardiac magnetic resonance imaging at 6 months and yearly. Computed tomographic scan of the aortic valve to assess for valve calcification was performed at last follow-up. RESULTS Hospital mortality was 0%. Mean follow-up was 6.5 years (range, 5.3-7.5 years). Freedom from structural valve deterioration, thromboembolism, endocarditis and reoperation was 100%, 100%, 72.7%, and 63.6%, respectively. There were 4 reoperations at 4, 13, 15, and 46 months, 3 of them owing to endocarditis and 1 owing to technical failure noted at the time of surgery. The remaining 7 patients are alive and well with a mean New York Heart Association class of 1.3 and normally functioning aortic valves with no calcification. CONCLUSIONS Truly stentless aortic valve replacement using autologous pericardium sutured directly onto the aortic wall is safe and feasible and has excellent durability up to 7.5 years with no calcification.
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Affiliation(s)
- K M John Chan
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton Hospital, London, United Kingdom.
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Murtuza B, Pepper JR, Jones C, Nihoyannopoulos P, Darzi A, Athanasiou T. Does stentless aortic valve implantation increase perioperative risk? A critical appraisal of the literature and risk of bias analysis. Eur J Cardiothorac Surg 2010; 39:643-52. [PMID: 20850984 DOI: 10.1016/j.ejcts.2010.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/25/2010] [Accepted: 08/05/2010] [Indexed: 11/27/2022] Open
Abstract
Stentless aortic valve replacement has potential benefits in terms of valve hemodynamics and clinical outcomes, although these may be offset by greater technical complexity of implantation with longer cardiopulmonary bypass and cross-clamp times compared with stented valves. Meta-analyses of the small number of published randomized trials have been limited by their lack of critical synthesis of the literature, including evaluation of the Risk of Bias. Our objective was to determine whether stentless aortic valves increase perioperative risk of mortality. We also examined secondary clinical outcomes of neurological, renal and respiratory complications as well as hemodynamic changes reported by studies following implantation of the two types of aortic prosthesis. The methodology used to answer this question was a rigorous meta-analysis of randomized controlled trials, using bias-assessment techniques designed to address limitations of conventional meta-analysis. Our findings show that many of the existing randomized trials have a high or uncertain risk of bias. Analysis of studies with low risk of bias reveals that stentless valves do not increase perioperative risk in terms of 30-day mortality and morbidity though neither do they exhibit benefits in hemodynamics or clinical outcomes compared with stented valves. Larger, more stringent randomized studies would be required to identify any robust clinical difference.
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Affiliation(s)
- Bari Murtuza
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Faculty of Medicine, Imperial College, UK.
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