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Ali-Hasan-Al-Saegh S, Takemoto S, Shafiei S, Yavuz S, Arjomandi Rad A, Amanov L, Merzah AS, Salman J, Ius F, Kaufeld T, Schmack B, Popov AF, Sabashnikov A, Ruhparwar A, Zubarevich A, Weymann A. Sutureless Aortic Valve Replacement with Perceval Bioprosthesis Superior to Transcatheter Aortic Valve Implantation: A Promising Option for the Gray-Zone of Aortic Valve Replacement Procedures-A State-of-the-Art Systematic Review, Meta-Analysis, and Future Directions. J Clin Med 2024; 13:4887. [PMID: 39201028 PMCID: PMC11355092 DOI: 10.3390/jcm13164887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/11/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Background: The management of patients with aortic valve pathologies can sometimes fall into a "gray zone", where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the "gray zone" of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan-Meier-based meta-analyses to compare the outcomes of SUAVR with the Perceval bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the Perceval bioprosthesis over mid-term and long-term follow-up periods. Methods: The PubMed, PubMed Central, OVID Medline, Cochrane Library, Embase, and Web of Science databases were systematically searched. All study types were included, except study protocols and animal studies, without time restrictions. The final search was carried out in May 2024. Results: No statistically significant differences were observed in permanent pacemaker implantation (PPI) rates between the two groups. SUAVR showed a lower incidence of new-onset myocardial infarction but was associated with higher rates of new-onset atrial fibrillation and major bleeding. TAVI had higher rates of left bundle branch block and major vascular complications. Conclusions: Our findings show that SUAVR has a lower incidence of complications and a favorable mid-term overall survival compared to TAVI. SUAVR has more advantages compared to TAVI and can be considered a valuable and promising option for the "grey zone" of aortic valve pathologies.
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Affiliation(s)
- Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Sho Takemoto
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
| | - Saeed Shafiei
- Department of Cardiac and Thoracic Vascular Surgery, Marburg University Hospital, 35043 Marburg, Germany
| | - Senol Yavuz
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, 16310 Bursa, Turkey
| | | | - Lukman Amanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Bastian Schmack
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Aron-Frederik Popov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield UB9 6JH, UK
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Alexander Weymann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
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Vendramin I, Bortolotti U, Livi U. Simplifying complex aortic root reoperations. JTCVS Tech 2024; 26:21. [PMID: 39156528 PMCID: PMC11329175 DOI: 10.1016/j.xjtc.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
| | | | - Ugolino Livi
- Cardiothoracic Department, University Hospital, Udine, Italy
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Spadaccio C, Nenna A, Pisani A, Laskawski G, Nappi F, Moon MR, Biancari F, Jassar AS, Greason KL, Shrestha ML, Bonaros N, Rose D. Sutureless Valves, a "Wireless" Option for Patients With Aortic Valve Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:382-407. [PMID: 39019533 DOI: 10.1016/j.jacc.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 07/19/2024]
Abstract
Transcatheter technologies triggered the recent revision of the guidelines that progressively widened the indications for the treatment of aortic stenosis. On the surgical realm, a technology avoiding the need for sutures to anchor the prosthesis to the aortic annulus has been developed with the aim to reduce the duration of cardiopulmonary bypass and simplify the process of valve implantation. In addition to a transcatheter aortic valve replacement (TAVR)-like stent that exerts a radial force, these so-called "rapid deployment valves" or "sutureless valves" for aortic valve replacement also have cuffs to improve sealing and reduce the risk of paravalvular leak. Despite promising, the actual advantage of sutureless valves over traditional surgical procedures (surgical aortic valve replacement) or TAVR is still debated. This review summarizes the current comparative evidence reporting outcomes of "sutureless valves" for aortic valve replacement to TAVR and surgical aortic valve replacement in the treatment of aortic valve stenosis.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom; Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Antonio Nenna
- Cardiovascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Angelo Pisani
- Cardiac Surgery, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Grzegorz Laskawski
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Marc R Moon
- Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, Texas, USA
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital/University of Helsinki, Helsinki, Finland
| | - Arminder S Jassar
- Cardiac Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - Kevin L Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Malakh L Shrestha
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA; Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany
| | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - David Rose
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
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Sugimori H, Nakao T, Okada Y, Okita Y, Yaku H, Kobayashi J, Uesugi H, Takanashi S, Ito T, Koyama T, Sakaguchi T, Yamamoto K, Yoshikawa Y, Sawa Y. Mid-term outcomes of surgical aortic valve replacement using a mosaic porcine bioprosthesis with concomitant mitral valve repair. Heart Vessels 2024; 39:252-265. [PMID: 37843552 DOI: 10.1007/s00380-023-02325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
This study retrospectively evaluated the mid-term outcomes of surgical aortic valve replacement (SAVR) using a stented porcine aortic valve bioprosthesis (Mosaic; Medtronic Inc., Minneapolis, MN, USA) with concomitant mitral valve (MV) repair. From 1999 to 2014, 157 patients (median [interquartile range] age, 75 [70-79] years; 47% women) underwent SAVR with concomitant MV repair (SAVR + MV repair), and 1045 patients (median [interquartile range] age, 76 [70-80] years; 54% women) underwent SAVR only at 10 centers in Japan as part of the long-term multicenter Japan Mosaic valve (J-MOVE) study. The 5-year overall survival rate was 81.5% ± 4.1% in the SAVR + MV repair group and 85.1% ± 1.4% in the SAVR only group, and the 8-year overall survival rates were 75.2% ± 5.7% and 78.1% ± 2.1%, respectively. Cox proportional hazards analysis showed no significant difference in the survival rates between the two groups (hazard ratio, 0.87; 95% confidence interval, 0.54-1.40; P = 0.576). Among women with mild or moderate mitral regurgitation who were not receiving dialysis, those who underwent SAVR + MV repair, were aged > 75 years, and had a preoperative left ventricular ejection fraction of 30-75% tended to have a lower mortality risk. In conclusion, this subgroup analysis of the J-MOVE cohort showed relevant mid-term outcomes after SAVR + MV repair.
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Affiliation(s)
- Haruhiko Sugimori
- Department of Cardiovascular Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan.
| | - Tatsuya Nakao
- Department of Cardiovascular Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Yukikatsu Okada
- Department of Cardiovascular Surgery, Midori Hospital, 1-16 Edayoshi, Nishi-ku, Kobe, Hyogo, 651-2133, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki General Hospital, 1-3-13 Kosobe-Machi, Takatsuki, Osaka, 569-1192, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshin-Machi, Suita, Osaka, 564-0018, Japan
| | - Hideyuki Uesugi
- Department of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4101, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital, 31-27 Omiya-Chyou, Saiwai-ku, Kawasaki, Kanagawa, 212-0014, Japan
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-Chyou, Nakamura-ku, Nagoya, Aichi, 453-0046, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-3-6 Minatojima, Chuo-ku, Kobe, Hyogo, 650-0045, Japan
| | - Kouji Yamamoto
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Tottori University, 4-101 Koyama-Cho, Minami, Tottori, 680-8550, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Permsuwan U, Singhatanadgige S, Boonpipattanapong K, Slisatkorn W, Chartrungsan A, Nitayavardhana P, Luangthong N, Porapakkham P, Yadee J. Cost-utility analysis of sutureless and rapid deployment versus conventional aortic valve replacement in patients with moderate to severe aortic stenosis in Thailand. PLoS One 2024; 19:e0296875. [PMID: 38241391 PMCID: PMC10798510 DOI: 10.1371/journal.pone.0296875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Sutureless and rapid deployment aortic valve replacement (SUAVR) has become an alternative to conventional aortic valve replacement (CAVR) for aortic stenosis (AS) treatment due to its advantages in reducing surgery time and improving outcomes. This study aimed to assess the cost-utility of SUAVR vs. CAVR treatment for patients with moderate to severe AS in Thailand. METHODS A two-part constructed model was used to estimate the lifetime costs and quality-adjusted life years (QALYs) from both societal and healthcare perspectives. Data on short-term mortality, complications, cost, and utility data were obtained from the Thai population. Long-term clinical data were derived from clinical studies. Costs and QALYs were discounted annually at 3% and presented as 2022 values. The incremental cost-effectiveness ratio (ICER) was calculated to determine additional cost per QALY gained. Deterministic and probabilistic sensitivity analyses were performed. RESULTS SUAVR treatment incurred higher costs compared with CAVR treatment from both societal (THB 1,733,355 [USD 147,897] vs THB 1,220,643 [USD 104,150]) and healthcare provider perspectives (THB 1,594,174 [USD 136,022] vs THB 1,065,460 [USD 90,910]). In addition, SUAVR treatment resulted in lower health outcomes, with 6.20 life-years (LYs) and 4.95 QALYs, while CAVR treatment achieved 6.29 LYs and 5.08 QALYs. SUAVR treatment was considered as a dominated treatment strategy using both perspectives. Sensitivity analyses indicated the significant impact of changes in utilities and long-term mortality on the model. CONCLUSION SUAVR treatment is not a cost-effective treatment strategy compared with CAVR treatment for patients with moderate-severe AS in Thailand, as it leads to higher costs and inferior health outcomes. Other important issues related to specific patients such as those with minimally invasive surgery, those undergoing AVR with concomitant procedures, and those with calcified and small aortic root should be taken into account.
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Affiliation(s)
- Unchalee Permsuwan
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Seri Singhatanadgige
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kawinnooch Boonpipattanapong
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Worawong Slisatkorn
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Angsu Chartrungsan
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prompak Nitayavardhana
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nutthawadee Luangthong
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pramote Porapakkham
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Jirawit Yadee
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Ph.D. Degree Program in Pharmacy, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Wang C, Xie Y, Zhang H, Yang P, Zhang Y, Lu C, Liu Y, Wang H, Xu Z, Hu J. Sutureless vs. rapid-deployment valve: a systemic review and meta-analysis for a direct comparison of intraoperative performance and clinical outcomes. Front Cardiovasc Med 2023; 10:1123487. [PMID: 37255707 PMCID: PMC10225698 DOI: 10.3389/fcvm.2023.1123487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
Background Sutureless and rapid-deployment valves are bioprostheses anchoring within the aortic annulus with few sutures, and they act as a hybrid of conventional surgical and transcatheter valves under aortic valve replacement. Considering that the 3F Enable valve is now off-market, the only two sutureless and rapid-deployment valves available on the world marketplace are the Perceval and Intuity valves. However, a direct comparison of the function of these two valves eludes researchers. Purpose Against this background, we performed this systematic review and meta-analysis comparing the intraoperative performance and early clinical outcomes between the Perceval valve and the Intuity valve under sutureless and rapid-deployment aortic valve replacement. Methods We systematically searched electronic databases through PubMed/MEDLINE, OvidWeb, Web of Science, and Cochrane Central Register of Controlled Trials (from the establishment of the database to November 17, 2022, without language restriction) for studies comparing the sutureless valve (the Perceval) and the rapid-deployment valve (the Intuity) under aortic valve replacement. Our primary outcomes were early mortality and postoperative transvalvular pressure gradients. The secondary outcomes were defined to include aortic cross-clamp and cardiopulmonary bypass time, paravalvular leak (any paravalvular leak, moderate-to-severe paravalvular leak) after aortic valve replacement, need for pacemaker implantation, postoperative neurological events (stroke), and intensive care unit stay. Results This meta-analysis included ten non-randomized trials with 3,526 patients enrolled (sutureless group = 1,772 and rapid-deployment group = 1,754). Quality assessments were performed, with the mean scores of the studies reading 6.90 (SD = 0.99) out of 9 according to the Newcastle-Ottawa Scale. Compared with rapid-deployment aortic valve replacement, sutureless aortic valve replacement was associated with higher mean and peak transvalvular pressure gradients postoperatively. In contrast, aortic cross-clamp and cardiopulmonary time were needed less in sutureless aortic valve replacement vs. rapid-deployment aortic valve replacement. There was no evidence of significant publication bias observed by the funnel plot and Egger's test. Conclusions For postoperative hemodynamics, sutureless aortic valve replacement was associated with increased mean and peak transvalvular pressure gradients compared with rapid-deployment aortic valve replacement. In sharp contrast, sutureless aortic valve replacement significantly reduced the amount of time needed for fixing the aortic cross-clamp and the cardiopulmonary bypass procedure. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022343884.
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Affiliation(s)
- Chenhao Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Xie
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongwei Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peng Yang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen Lu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haiyue Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenyuan Xu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiovascular Surgery, Guang'an Hospital of West China Hospital, Sichuan University, Guang'an, Sichuan, China
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Sakata T, De La Pena C, Ohira S. Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations. Vasc Health Risk Manag 2023; 19:169-180. [PMID: 37016696 PMCID: PMC10066891 DOI: 10.2147/vhrm.s374410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Sutureless or rapid deployment valves in the setting of aortic valve replacement (AVR) is an emerging surgical technique using the transcatheter valve technology, which may lead to reduction in cross-clamp time and potentially better hemodynamics compared to a stented bioprosthetic valve. The absence of subannular pledgets results to excellent hemodynamic performance with reduced turbulent flow and larger effective orifice area. However, complications from both surgical and transcatheter AVR may still occur and impact survival. The incidence of paravalvular leakage and permanent pacemaker implantation are not low. Although technical modifications can improve these outcomes, there is a learning curve effect. Therefore, technical and anatomical considerations as well as better patient selection are paramount for better outcomes. In this review, we discuss the use of sutureless or rapid deployment valves in setting of (1) complex procedures, (2) minimally invasive AVR, and (3) small aortic annulus. The advantage of sutureless or rapid deployment valves in terms of mortality remains to be clarified; therefore, it is necessary to accumulate long-term outcomes in an appropriate patient cohort.
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Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corazon De La Pena
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Correspondence: Suguru Ohira, Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Macy Pavilion, Valhalla, NY, 10595, USA, Tel +1 404 234 5433, Email
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8
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Dokollari A, Torregrossa G, Sicouri S, Veshti A, Margaryan R, Cameli M, Mandoli GE, Maccherini M, Montesi G, Cabrucci F, Coku L, Arora R, Li QR, Bonacchi M, Gelsomino S. Pearls, pitfalls, and surgical indications of the Intuity TM heart valve: A rapid deployment bioprosthesis. A systematic review of the literature. J Card Surg 2022; 37:5411-5417. [PMID: 36403259 DOI: 10.1111/jocs.17231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To highlight short- and long-term clinical outcomes of the Intuity TM rapid deployment prosthesis for surgical aortic valve replacement. METHODS We reviewed on PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL, and Google Scholar for clinical trials, retrospective clinical studies, meta-analysis, and gray literature. RESULTS Fourty-five clinical studies with 12.714 patients were included in the analysis. Thirty-day mortality ranged from 3.8% for Intuity and 3.9% for transcatheter aortic valve replacement (TAVR). The incidence of paravalvular leak (PVL) (Intuity 0% and TAVR 2.17%), permanent pacemaker implantation (Intuity 11.11% and TAVR 12.5%), stroke (Intuity 2.2% and TAVR 2.6%), myocardial infarction (MI) (Intuity 0% and TAVR 1%), were all higher in the TAVR group. Compared to other sutured bioprosthesis (SB), mortality ranged from 0% to 3.9% for Intuity and 0%-6.9% for SB. Long-term cardiac mortality ranged from 0.9% to 1.55% for Intuity and 1.4%-3.3% for the Perceval valve. The incidence of PVL (Intuity 0.24%-0.7% and Perceval 0%-1%), endocarditis (Intuity 0.2%-0.7% and Perceval 1.6%-6.6%), stroke (Intuity 0.36%-1.4% and Perceval 0%-0.8%), MI (Intuity 0.07%-0.26%), and SVD (Intuity 0.12%-0.7% and Perceval 0%) were comparable. Compared to standard full sternotomy (SFS), minimally invasive surgery (MINV) mortality ranged from 0% to 4.3% for MINV and 0%-2.1% for SFS. Hospital costs outcomes ranged from $37,187-$44,368 for the Intuity, $69,389 for TAVR, and $13,543 for SB. Intuity short-term mortality ranged between 0.9% and 12.4% while long-term mortality ranged between 2.6% and 20%. CONCLUSIONS This manuscript provides a 360° overview of the current rapid deployments, sutureless, and TAVR prosthesis.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Altin Veshti
- Department of Cardiac Surgery, Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Matteo Cameli
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Giulia Elena Mandoli
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Massimo Maccherini
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Gianfranco Montesi
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Francesco Cabrucci
- Department of Cardiac Surgery/Cardiology, University of Siena, Siena, Italy
| | - Lindita Coku
- Department of Cardiac Surgery, Appalachian Regional Health, University of Kentucky, Hazard, Kentucky, USA
| | - Rakesh Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Qiao Ri Li
- 2010 Vision Associates, Toronto, Ontario, Canada
| | - Massimo Bonacchi
- Department of Cardiac Surgery/Cardiology, University of Siena, Siena, Italy
| | - Sandro Gelsomino
- Department of Cardiac Surgery, CARIM Maastricht Medical University, Maastricht, Netherlands
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9
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Herrmann HC, Pibarot P, Wu C, Hahn RT, Tang GHL, Abbas AE, Playford D, Ruel M, Jilaihawi H, Sathananthan J, Wood DA, De Paulis R, Bax JJ, Rodes-Cabau J, Cameron DE, Chen T, Del Nido PJ, Dweck MR, Kaneko T, Latib A, Moat N, Modine T, Popma JJ, Raben J, Smith RL, Tchetche D, Thomas MR, Vincent F, Yoganathan A, Zuckerman B, Mack MJ, Leon MB. Bioprosthetic Aortic Valve Hemodynamics: Definitions, Outcomes, and Evidence Gaps: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:527-544. [PMID: 35902177 DOI: 10.1016/j.jacc.2022.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 12/23/2022]
Abstract
A virtual workshop was organized by the Heart Valve Collaboratory to identify areas of expert consensus, areas of disagreement, and evidence gaps related to bioprosthetic aortic valve hemodynamics. Impaired functional performance of bioprosthetic aortic valve replacement is associated with adverse patient outcomes; however, this assessment is complicated by the lack of standardization for labelling, definitions, and measurement techniques, both after surgical and transcatheter valve replacement. Echocardiography remains the standard assessment methodology because of its ease of performance, widespread availability, ability to do serial measurements over time, and correlation with outcomes. Management of a high gradient after replacement requires integration of the patient's clinical status, physical examination, and multimodality imaging in addition to shared patient decisions regarding treatment options. Future priorities that are underway include efforts to standardize prosthesis sizing and labelling for both surgical and transcatheter valves as well as trials to characterize the consequences of adverse hemodynamics.
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Affiliation(s)
- Howard C Herrmann
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Philippe Pibarot
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA
| | | | - Amr E Abbas
- Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - David Playford
- The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jeroen J Bax
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Josep Rodes-Cabau
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Duke E Cameron
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tiffany Chen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pedro J Del Nido
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tsuyoshi Kaneko
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Neil Moat
- Abbott Structural Heart, Santa Clara, California, USA
| | - Thomas Modine
- Hopital Cardiologique de Haut Leveque, Bordeaux, France
| | | | - Jamie Raben
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Robert L Smith
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | | | | | | | - Ajit Yoganathan
- Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Bram Zuckerman
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael J Mack
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, New York, USA
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10
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Fabre O, Radutoiu M, Carjaliu I, Rebet O, Gautier L, Hysi I. Recent improvement in operative techniques lead to lower pacemaker rate after Perceval implant. Interact Cardiovasc Thorac Surg 2022; 35:6617842. [PMID: 35751610 PMCID: PMC9295764 DOI: 10.1093/icvts/ivac182] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/07/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Decrease in the pacemaker rate after Perceval implants in the last 5 years. The left Y-axis shows the percent of permanent cardiac pacemakers implanted. The right Y-axis (in green) shows the number of Perceval valves implanted. ![]()
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Affiliation(s)
- Olivier Fabre
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Mihai Radutoiu
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Ionut Carjaliu
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Olivier Rebet
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Laurence Gautier
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
| | - Ilir Hysi
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard , Ramsay, Santé, France
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11
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De Martino A, Milano AD, Barbera MD, Thiene G, Bortolotti U. The Caged-Ball Prosthesis 60 Years Later: A Historical Review of a Cardiac Surgery Milestone. Tex Heart Inst J 2022; 49:479864. [PMID: 35390164 DOI: 10.14503/thij-20-7267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sixty years ago, 2 cardiac operations dramatically influenced the survival of patients with valvular heart disease. The replacement of an aortic valve by Dwight Harken and of a mitral valve by Albert Starr with mechanical caged-ball valves, both in 1960, was a true milestone in the history of cardiac surgery and the beginning of a long journey toward prosthetic valve replacement full of expectations, hopes, and dreams fulfilled. Caged-ball prostheses underwent numerous modifications in design and materials to improve reliability and prevent specific mechanical and thrombogenic complications. Clinical and pathologic experience gained during the past 6 decades has enabled the development of safe, durable, and minimally thrombogenic mechanical prostheses.
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Affiliation(s)
- Andrea De Martino
- Cardiothoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Aldo D Milano
- Division of Cardiac Surgery, University of Bari, Bari, Italy
| | - Mila Della Barbera
- Department of Cardiovascular Pathology, University of Padua, Padua, Italy
| | - Gaetano Thiene
- Department of Cardiovascular Pathology, University of Padua, Padua, Italy
| | - Uberto Bortolotti
- Cardiothoracic and Vascular Department, University Hospital, Pisa, Italy
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12
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Yajima S, Satoh A, Sekiya N, Yamazaki S, Uemura H, Tanaka H, Yamamura M, Sakaguchi T. Perceval sutureless aortic valve replacement after ascending aortic replacement. Clin Case Rep 2021; 9:e05126. [PMID: 34917364 PMCID: PMC8645176 DOI: 10.1002/ccr3.5126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022] Open
Abstract
In patients with a narrow sinotubular junction, small sinus of Valsalva, or extensibility loss in the aortic root, aortic valve replacement (AVR) with a standard valve is challenging due to limited surgical field. Detailed preoperative measurements of the aortic root render performing AVR using the Perceval valve easy.
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Affiliation(s)
- Shin Yajima
- Department of Cardiovascular SurgeryHyogo College of MedicineNishinomiya CityJapan
| | - Ayaka Satoh
- Department of Cardiovascular SurgeryHyogo College of MedicineNishinomiya CityJapan
| | - Naosumi Sekiya
- Department of Cardiovascular SurgeryHyogo College of MedicineNishinomiya CityJapan
| | - Sachiko Yamazaki
- Department of Cardiovascular SurgeryHyogo College of MedicineNishinomiya CityJapan
| | - Hisashi Uemura
- Department of Cardiovascular SurgeryHyogo College of MedicineNishinomiya CityJapan
| | - Hiroe Tanaka
- Department of Cardiovascular SurgeryHyogo College of MedicineNishinomiya CityJapan
| | - Mitsuhiro Yamamura
- Department of Cardiovascular SurgeryHyogo College of MedicineNishinomiya CityJapan
| | - Taichi Sakaguchi
- Department of Cardiovascular SurgeryHyogo College of MedicineNishinomiya CityJapan
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13
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Bottigliengo D, Baldi I, Lanera C, Lorenzoni G, Bejko J, Bottio T, Tarzia V, Carrozzini M, Gerosa G, Berchialla P, Gregori D. Oversampling and replacement strategies in propensity score matching: a critical review focused on small sample size in clinical settings. BMC Med Res Methodol 2021; 21:256. [PMID: 34809559 PMCID: PMC8609749 DOI: 10.1186/s12874-021-01454-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Propensity score matching is a statistical method that is often used to make inferences on the treatment effects in observational studies. In recent years, there has been widespread use of the technique in the cardiothoracic surgery literature to evaluate to potential benefits of new surgical therapies or procedures. However, the small sample size and the strong dependence of the treatment assignment on the baseline covariates that often characterize these studies make such an evaluation challenging from a statistical point of view. In such settings, the use of propensity score matching in combination with oversampling and replacement may provide a solution to these issues by increasing the initial sample size of the study and thus improving the statistical power that is needed to detect the effect of interest. In this study, we review the use of propensity score matching in combination with oversampling and replacement in small sample size settings. Methods We performed a series of Monte Carlo simulations to evaluate how the sample size, the proportion of treated, and the assignment mechanism affect the performances of the proposed approaches. We assessed the performances with overall balance, relative bias, root mean squared error and nominal coverage. Moreover, we illustrate the methods using a real case study from the cardiac surgery literature. Results Matching without replacement produced estimates with lower bias and better nominal coverage than matching with replacement when 1:1 matching was considered. In contrast to that, matching with replacement showed better balance, relative bias, and root mean squared error than matching without replacement for increasing levels of oversampling. The best nominal coverage was obtained by using the estimator that accounts for uncertainty in the matching procedure on sets of units obtained after matching with replacement. Conclusions The use of replacement provides the most reliable treatment effect estimates and that no more than 1 or 2 units from the control group should be matched to each treated observation. Moreover, the variance estimator that accounts for the uncertainty in the matching procedure should be used to estimate the treatment effect. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01454-z.
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Affiliation(s)
- Daniele Bottigliengo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121, Padova, Italy
| | - Ileana Baldi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121, Padova, Italy
| | - Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121, Padova, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121, Padova, Italy
| | - Jonida Bejko
- Department of Cardiac, Thoracic,Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic,Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic,Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimiliano Carrozzini
- Department of Cardiac, Thoracic,Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic,Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121, Padova, Italy.
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14
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Berretta P, Meuris B, Kappert U, Andreas M, Fiore A, Solinas M, Misfeld M, Carrel TP, Villa E, Savini C, Santarpino G, Teoh K, Albertini A, Fischlein T, Martinelli G, Mignosa C, Glauber M, Shrestha M, Laufer G, Phan K, Yan T, Di Eusanio M. Sutureless versus rapid deployment aortic valve replacement: results from a multicentric registry. Ann Thorac Surg 2021; 114:758-765. [PMID: 34563505 DOI: 10.1016/j.athoracsur.2021.08.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND To compare clinical and hemodynamic in-hospital outcomes of patients undergoing sutureless versus rapid deployment aortic valve replacement (SURD-AVR) in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS We examined 4695 patients who underwent isolated or combined SURD-AVR. The "sutureless" Perceval valve was used in 3133 patients and the "rapid deployment" Intuity in 1562. Potential confounding factors were addressed by the use of propensity score matching. After matching, 2 well-balanced cohorts of 823 pairs (isolated SURD-AVR) and 467 pairs (combined SURD-AVR) were created. RESULTS Patients who received Perceval and Intuity valves showed similar in-hospital mortality and rate of major postoperative complications. Perceval was associated shorter cross clamp and cardiopulmonary bypass time. In the isolated SURD-AVR group, patients receiving Perceval were more likely to undergo anterior right thoracotomy incision. Postoperative transvalvular gradients were significantly lower for the Intuity valve compared to those of the Perceval valve, either in isolated and combined SURD-AVR. The Intuity valve was associated with a lower rate of postoperative mild aortic regurgitation. CONCLUSIONS Our results confirm the safety and efficacy of SURD-AVR regardless of the valve type. The Perceval valve was associated with reduced operative times and increased anterior right thoracotomy incision. The Intuity valve showed superior hemodynamic outcomes and a lower incidence of postoperative mild aortic regurgitation.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Antonio Fiore
- Henri Mondor Hospital, University of Paris, Paris, France
| | | | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy
| | - Giuseppe Santarpino
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Italy; Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy; Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Kevin Teoh
- Southlake Regional Health Centre, Ontario, Canada
| | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital GVM care & research, Cotignola, Italy
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | | | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | - Mattia Glauber
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | | | - Ghunter Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Tristan Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia; The Collaborative Research (CORE) Group
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy; The Collaborative Research (CORE) Group
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15
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Sievers HH, Ensminger S. Update on the German Ross Registry. Ann Cardiothorac Surg 2021; 10:515-517. [PMID: 34422565 DOI: 10.21037/acs-2020-rp-154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/15/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig Holstein, Lübeck, Germany
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16
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Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations. J Cardiovasc Dev Dis 2021; 8:jcdd8070074. [PMID: 34201997 PMCID: PMC8305208 DOI: 10.3390/jcdd8070074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/06/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Sutureless and rapid-deployment bioprostheses have been introduced as alternatives to traditional prosthetic valves to reduce cardiopulmonary and aortic cross-clamp times during aortic valve replacement. These devices have also been employed in extremely demanding surgical settings, as underlined in the present review. Searches on the PubMed and Medline databases aimed to identify, from the English-language literature, the reported cases where both sutureless and rapid-deployment prostheses were employed in challenging surgical situations, usually complex reoperations sometimes even performed as bailout procedures. We have identified 25 patients for whom a sutureless or rapid-deployment prosthesis was used in complex redo procedures: 17 patients with a failing stentless bioprosthesis, 6 patients with a failing homograft, and 2 patients with the failure of a valve-sparing procedure. All patients survived reoperation and were reported to be alive 3 months to 4 years postoperatively. Sutureless and rapid-deployment bioprostheses have proved effective in replacing degenerated stentless bioprostheses and homografts in challenging redo procedures. In these settings, they should be considered as a valid alternative not only to traditional prostheses but also in selected cases to transcatheter valve-in-valve solutions.
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17
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Moscarelli M, Santarpino G, Athanasiou T, Mastroroberto P, Fattouch K, Nasso G, Speziale G. A pooled analysis of pacemaker implantation after Perceval sutureless aortic valve replacement. Interact Cardiovasc Thorac Surg 2021; 33:501-509. [PMID: 34000013 DOI: 10.1093/icvts/ivab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/15/2021] [Accepted: 03/31/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We performed a literature meta-analysis to estimate the rate of pacemaker implantation after Perceval sutureless aortic valve replacement. METHODS Pertinent articles were identified from the PubMed, Google Scholar, Ovid MEDLINE and Ovid EMBASE databases. Eligible studies reported the de novo incidence of postoperative pacemaker implantation after Perceval valve surgery. Among 394 articles retrieved, 26 studies including 9492 patients met the inclusion criteria. RESULTS The pooled event rate for postoperative pacemaker implantation was 7% [95% confidence interval (CI) 6-9%]; however, significant heterogeneity was observed across studies. In a sub-analysis, there was no difference between the rates of pacemaker implantation calculated from multicentre and registry studies (8 studies, 6845 patients; 7%, 95% CI 5-10%) and single-centre studies (18 studies, 2647 patients; 7%, 95% CI 5-9%; P = 0.75). Implantation rates were similar in high-volume studies (16 studies, 9121 patients; 7%, 95% CI 5-8%) than in low-volume studies (10 studies, 371 patients; pooled rate: 7%, 95% CI 4-14%; P = 0.5). Postoperative pacemaker implantation rates tended to decrease over time. CONCLUSIONS With a pooled event rate of 7%, postoperative pacemaker implantation remains an important limitation of Perceval sutureless valve surgery, although we observed a degree of variability across included studies. The resultant findings provide a useful estimate for physicians and patients and can serve as a benchmark for future comparative studies. PROSPERO REGISTRATION NUMBER CRD42020188397.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Imperial College, NHLI, Hammersmith Hospital, London, UK
| | - Giuseppe Santarpino
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | | | - Pasquale Mastroroberto
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
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18
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Sohn SH, Kang Y, Kim JS, Choi JW, Jang MJ, Hwang HY. Direct comparison of rapid deployment versus sutureless aortic valve replacement: a meta-analysis. J Thorac Dis 2021; 13:2203-2215. [PMID: 34012571 PMCID: PMC8107528 DOI: 10.21037/jtd-20-3548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background This meta-analysis was conducted to compare the procedural and early outcomes of aortic valve replacement (AVR) using rapid deployment valve (RD group) versus sutureless valve (SU group). Methods A literature search of 5 online databases was conducted. The primary outcomes were mean transvalvular pressure gradient (MPG) after AVR, the incidence of paravalvular leak (PVL) and the need for a permanent pacemaker implantation (PPI). The secondary outcomes included aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times, early mortality and other postoperative complications, such as atrial fibrillation, bleeding reoperation and stroke. Results Eight articles were included, and all outcomes except MPG after AVR in matched valve sizes were extracted from 7 studies (RD group =842 patients and SU group =1,386 patients). The pooled analysis demonstrated a lower MPG in the RD group than in the SU group, with mean difference (MD) of 2.64 mmHg. The pooled risk ratios of any PVL and grade ≥2 (or moderate) PVL were not significantly different between the groups; however, the incidence of PPI was significantly lower in the RD group than in the SU group, with a risk ratio of 0.69. The pooled analyses showed that the ACC and CPB times were significantly longer in the RD group than in the SU group, with weighted MDs of 8.74 (P<0.001) and 9.94 (P<0.001) minutes, respectively. The risks of early mortality and other postoperative complications were not significantly different between the groups. Conclusions AVR using RD valve was associated with better valve hemodynamics in terms of the MPG than AVR using SU valve, and better outcomes were observed in the RD group regarding PPI. Procedural times were longer in AVR using RD valve than SU valve. Early clinical outcomes showed no difference between RD and SU valve.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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19
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Lam KY, Reardon MJ, Yakubov SJ, Modine T, Fremes S, Tonino PAL, Tan ME, Gleason TG, Harrison JK, Hughes GC, Oh JK, Head SJ, Huang J, Deeb GM. Surgical sutureless and sutured aortic valve replacement in low-risk patients. Ann Thorac Surg 2021; 113:616-622. [PMID: 33794164 DOI: 10.1016/j.athoracsur.2021.03.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Randomized clinical trials have shown that transcatheter aortic valve replacement (TAVR) is noninferior to surgery in low surgical risk patients. We compared outcomes in patients treated with a sutured (stented or stentless) or sutureless surgical valve from the Evolut Low Risk Trial. METHODS The Evolut Low Risk Trial enrolled patients with severe aortic stenosis and low surgical risk. Patients were randomized to self-expanding TAVR or surgery. Use of sutureless or sutured valves was at the surgeons' discretion. RESULTS There were 680 patients who underwent surgical aortic valve implantation (205 sutureless, 475 sutured). The VARC-2 30-day safety composite endpoint was similar in the sutureless and sutured group (10.8% vs 11.0%, P=.93). All-cause mortality between groups was similar between groups at 30 days (0.5% vs 1.5%, P=.28) and 1 year (3.3% vs 2.6%, P=.74). Disabling stroke was also similar at 30 days (2.0% vs 1.5%, P=.65) and 1 year (2.6% vs 2.2%, P=.76). Permanent pacemaker implantation at 30 days was significantly higher in the sutureless compared with the sutured group (14.4% vs 2.9%, P<.001). AV-related hospitalizations occurred more often at 1 year with sutureless valves (9.1% vs 5.1%, P=.04). Mean gradients 1 year after sutureless and sutured AVR were 9.9±4.2 vs 11.7±4.7mm Hg (P<.001). CONCLUSIONS Among low-risk patients, sutureless versus sutured valve use did not demonstrate a benefit in terms of 30-day complications and produced marginally better hemodynamics, but with an increased rate of pacemaker implantation and valve-related hospitalizations.
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Affiliation(s)
- Ka Yan Lam
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Debakey Heart and Vascular Center, Houston, TX
| | - Steven J Yakubov
- Department of Cardiology, Riverside Methodist - Ohio Health, Columbus, OH
| | - Thomas Modine
- Department of Cardiac Surgery, Lille University Hospital, Lille, France
| | - Stephen Fremes
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Pim A L Tonino
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - M Erwin Tan
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | | | | | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | | - G Michael Deeb
- Departments of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, MI
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20
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Schulte LJ, Maniar HS. Rapid Deployment Valves in Aortic Valve Replacement: Is Brevity the Soul of It? Ann Thorac Surg 2020; 112:572. [PMID: 33309726 DOI: 10.1016/j.athoracsur.2020.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Linda Jin Schulte
- Washington University School of Medicine, 1 Barnes Jewish Hospital Plaza, St Louis, MO 63110
| | - Hersh S Maniar
- Washington University School of Medicine, 1 Barnes Jewish Hospital Plaza, St Louis, MO 63110.
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21
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Martínez-Comendador JM, Estevez-Cid F, González Barbeito M, Velasco García De Sierra C, Bouzas Mosquera A, Barbeito C, Cuenca Castillo J, Herrera-Noreña J. Mid-term assessment of structural valve deterioration of perceval S sutureless prosthesis using the last European consensus definition. Interact Cardiovasc Thorac Surg 2020; 32:499-505. [PMID: 33881147 DOI: 10.1093/icvts/ivaa299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Durability of sutureless aortic bioprosthetic valves remains a major issue. The aim of this study was to assess structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) of the Perceval bioprosthesis using the new proposed standardized definitions. METHODS All patients who underwent aortic valve replacement with sutureless Perceval S prostheses up to September 2016 were included. Clinical and echocardiographic follow-up was performed. New standardized definitions were used to assess the durability of sutureless bioprosthetic valves. From 2013 to 2016, 214 patients were included. RESULTS The mean age and EuroSCORE II were 79 years and 2.74. Thirty-day mortality was 0.47%. The survival rate was 96.8%, 88.1% and 85.7% at 1, 3 and 4 years, respectively. The median echocardiographic follow-up was 3.28 years. The mean pressure gradient was 11.3 mmHg. No cases showed evidence of severe SVD, 17 patients had moderate SVD with a mean pressure gradient of 24 mmHg and 8 patients had definite late BVF. The incidence of moderate SVD and BVF at 4 years was 8.8% and 2.9%, respectively. CONCLUSIONS Mid-term follow-up to 6.3 years after aortic valve replacement with the Perceval bioprosthesis documents favourable haemodynamic and clinical outcomes and low rates of SVD and BVF.
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Affiliation(s)
| | - Francisco Estevez-Cid
- Department of Cardiovascular Surgery, Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | | | - Cayetana Barbeito
- Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain
| | | | - José Herrera-Noreña
- Department of Cardiovascular Surgery, Hospital Universitario A Coruña, A Coruña, Spain
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22
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Carrel T, Heinisch PP. History, development and clinical perspectives of sutureless and rapid deployment surgical aortic valve replacement. Ann Cardiothorac Surg 2020; 9:375-385. [PMID: 33102176 DOI: 10.21037/acs-2020-surd-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Degenerative aortic stenosis is the most frequent valvular heart disease in industrialized countries. Conservative treatment may beneficially influence symptoms but is never successful. Surgical aortic valve replacement (SAVR) was the only recognized treatment option to provide substantially prolonged survival until 2008. Operative mortality of isolated SAVR has been reported as low as 0.5% to 1% in experienced institutions, while long-term survival is close to that observed in a control healthy population of similar age. A multitude of studies have demonstrated the beneficial effects of SAVR with regard to improvement in quality of life and physical performance in the majority of symptomatic patients. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as an equal treatment modality, first in patients with high surgical risk and more recently in patients with intermediate and low surgical risk. Paravalvular regurgitation and the higher rate of pacemaker implantation remain points of consideration. Additionally, the long-term durability of TAVI devices and occurrence of stroke late after TAVI require additional analyses. Sutureless (SU-SAVR) and rapid deployment valve (R-SAVR) were designed to simplify and accelerate a conventional or less invasive surgical procedure while allowing complete excision of the calcified native valve. From 3 different implants tested more than 10 to 15 years ago, only two are available on the market today: the Perceval® valve from Liva Nova and the Intuity® sutureless prosthesis from Edwards Lifesciences. There has been extensive experience with these two devices in previous years and the results obtained are comparable to those observed following the use of conventional implants. The sutureless devices may be of particular interest for more complex and combined surgical procedures. This review summarizes the sutureless (SU-SAVR) and rapid deployment valve technologies and presents a clinical outlook for the patient population managed with these devices.
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Affiliation(s)
- Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
| | - Paul Philipp Heinisch
- Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
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23
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Flynn CD, Williams ML, Chakos A, Hirst L, Muston B, Tian DH. Sutureless valve and rapid deployment valves: a systematic review and meta-analysis of comparative studies. Ann Cardiothorac Surg 2020; 9:364-374. [PMID: 33102175 DOI: 10.21037/acs-2020-surd-27] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The treatment of aortic valve disease is the most common valvular surgery in industrialized nations, with 3-9% of the population over the age of eighty having at least moderate aortic stenosis. As transcatheter aortic valve replacement (TAVR) has become more established, newer surgical prostheses have been developed with a variety of anchoring systems that do not rely solely on sutures to hold the valve in an appropriate position. The Edwards Intuity valve is a bovine pericardial prosthesis that is modelled on the widely implanted Perimount MagnaEase aortic prosthesis. The Perceval valve is a bovine pericardial valve attached to a self-expanding nitinol stent, which uses the radial force exerted on the patient's aortic annulus and aortic root by the stent portion to hold the valve in position. This meta-analysis compares the outcomes of comparative studies of these two valve systems. Methods This systematic review and meta-analysis compares the outcomes of rapid deployment valves (RDV) and sutureless valves (SURD) and was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and guidance. The search strategy interrogated six electronic databases. Outcomes measured included all-cause mortality at latest follow up, stroke, cross-clamp and cardiopulmonary bypass (CPB) times, pacemaker implantation rates, paravalvular leak and post-operative transvalvular gradient. Results The search strategy identified 407 unique papers for initial assessment with seven studies qualifying for inclusion in the analysis. The outcomes of 4,076 patients (1,650 RDV, 2,426 SURD) were included. There was no difference in mortality, stroke or moderate or worse paravalvular regurgitation between the two groups. SURD had significantly shorter CPB time by 15.7 minutes [95% confidence interval (CI): 4.2-27.1; P=0.007] and a shorter cross-clamp time by 11.3 minutes (95% CI: 6.3-16.3; P<0.001) compared to RDV. RDV had a lower post-operative transvalvular gradient by 2.5 mmHg (95% CI: 1.2-3.8; P<0.001) and a lower rate of mild paravalvular regurgitation (OR 2.51; 95% CI: 1.435-4.768; P=0.004). Conclusions Both valve types have an adequate safety profile and are comparable to conventional sutured prostheses. There was a significant reduction in cross-clamp and CPB times associated with SURD. This may be of benefit for patients requiring multiple concomitant procedures and increases the utility of minimally invasive valve replacement. However, SURD was associated with higher post-operative transvalvular gradients and a higher incidence of paravalvular regurgitation.
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Affiliation(s)
- Campbell D Flynn
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Melbourne, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Michael L Williams
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Adam Chakos
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Lucy Hirst
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Benjamin Muston
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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24
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De Martino A, Falcetta G, Milano AD, Bortolotti U. Modern concepts from old ideas in manufacture of cardiac valve prostheses. Indian J Thorac Cardiovasc Surg 2020; 36:502-505. [PMID: 33061161 PMCID: PMC7525892 DOI: 10.1007/s12055-020-00941-0] [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: 12/12/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/29/2022] Open
Abstract
In reviewing the history of mechanical prosthetic valves, it appears evident how many improvements and technical advances have been obtained in this field. Looking to the past, it must also be underlined how some old concepts, which can be considered quite revolutionary for those years, clearly indicate the great skill and ingenuity of those who conceived them. Old ideas have been revitalized by modern concepts, and this is exemplified when considering the developments of bileaflet and sutureless prostheses.
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Affiliation(s)
- Andrea De Martino
- Cardiothoracic Department, University Hospital of Pisa, Sezione Autonoma di Cardiochirurgia Universitaria, Via Paradisa 2, 56124 Pisa, Italy
| | - Giosuè Falcetta
- Cardiothoracic Department, University Hospital of Pisa, Sezione Autonoma di Cardiochirurgia Universitaria, Via Paradisa 2, 56124 Pisa, Italy
| | | | - Uberto Bortolotti
- Cardiothoracic Department, University Hospital of Pisa, Sezione Autonoma di Cardiochirurgia Universitaria, Via Paradisa 2, 56124 Pisa, Italy
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25
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Di Eusanio M, Berretta P. The sutureless and rapid-deployment aortic valve replacement international registry: lessons learned from more than 4,500 patients. Ann Cardiothorac Surg 2020; 9:289-297. [PMID: 32832410 PMCID: PMC7415696 DOI: 10.21037/acs-2020-surd-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/28/2020] [Indexed: 01/04/2023]
Abstract
The treatment options for patients with aortic valve disease have considerably expanded over the last decade. The remarkable advances in catheter-based technology, the popularizing of minimally invasive (MI) surgery, and the introduction of new valve technologies, such as sutureless and rapid-deployment (SURD) valves have led to a paradigm shift in the management of aortic valve pathologies. Yet, given their recent introduction, the current evidence on sutureless and rapid-deployment aortic valve replacement (SURD-AVR) has been limited thus far. The Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR) was established in 2015 by a consortium of 18 research centers to assess safety, efficacy, short- and long-term outcomes of SURD-AVR interventions. The present keynote lecture aims to assess and comment on the real-world evidence for SURD-AVR surgery generated from the SURD-IR.
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Affiliation(s)
- Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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26
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Williams ML, Flynn CD, Mamo AA, Tian DH, Kappert U, Wilbring M, Folliguet T, Fiore A, Miceli A, D'Onofrio A, Cibin G, Gerosa G, Glauber M, Fischlein T, Pollari F. Long-term outcomes of sutureless and rapid-deployment aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg 2020; 9:265-279. [PMID: 32832408 DOI: 10.21037/acs-2020-surd-25] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Sutureless and rapid-deployment aortic valve replacement (SURD-AVR) has become a prominent area of research as the medical community evaluate its place amongst other aortic valve interventions. The main advantages of SURD-AVR established to date are the reduced cross-clamp and cardiopulmonary bypass (CPB) times, as well as facilitating minimally invasive surgery in high-risk surgical patients. This current systematic review and meta-analysis, to our knowledge, is the first focusing on long-term outcomes regarding safety, efficacy and durability of SURD-AVR from available current literature. Methods A literature search via six electronic databases was performed from their inception to November 2019. Inclusion criteria for this systematic review included survival and postoperative echocardiographic outcomes greater than five years in patients who underwent SURD-AVR with either Perceval or Intuity valves. Studies were identified and data extracted by two independent reviewers. Long-term survival outcomes were aggregated using digitized Kaplan-Meier curves where available. Results After applying predefined inclusion and exclusion criteria, four studies were identified for review. All four studies were observational and in total reported data for 1,998 patients. Almost half (42.4%) of patients underwent SURD-AVR via full sternotomy, with almost one third (30.1%) also undergoing concomitant cardiac procedures. Aggregate overall survival rates at 1-, 2-, 3-, and 5-year follow-up were 94.9%, 91.2%, 89.0%, and 84.2%, respectively. Incidence of strokes (4.8%), severe paravalvular leaks (PVLs) (1.5%) and permanent pacemaker (PPM) insertion (8.2%) at up to 5-year follow-up were acceptable. At 5-year follow-up hemodynamic outcomes were also acceptable for mean pressure gradient (MPG) (range, 8.8-13.6 mmHg), peak pressure gradient (PPG) (range, 18.9-21.1 mmHg) and effective orifice area (EOA) (range, 1.5-1.8 cm2). Conclusions Evaluation of the evidence reporting long-term outcomes of SURD-AVR suggests that it is a safe procedure for AVR with low rates of complications. Long-term outcomes presented in this review show that not only does SURD-AVR have acceptable survival rates, but also good hemodynamic performance at 5-year follow-up.
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Affiliation(s)
- Michael L Williams
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Campbell D Flynn
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Melbourne, Australia
| | - Andrew A Mamo
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Thierry Folliguet
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Antonio Miceli
- Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | | | - Giorgia Cibin
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio - Gruppo San Donato, Milano, Italy
| | - Theodor Fischlein
- Cardiac Surgery, Paracelsus Medical University - Klinikum Nürnberg, Nuremberg, Germany
| | - Francesco Pollari
- Cardiac Surgery, Paracelsus Medical University - Klinikum Nürnberg, Nuremberg, Germany
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27
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Pal N, Jones D, Rice G, Sinhal A. Case report describing late balloon dilatation as a treatment for paravalvular leak with intuity elite rapid deployment valve. Catheter Cardiovasc Interv 2019; 96:E292-E294. [PMID: 31859442 DOI: 10.1002/ccd.28659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/22/2019] [Accepted: 12/08/2019] [Indexed: 11/11/2022]
Abstract
Use of sutureless bioprostheses for aortic valve replacement has increased in recent years as compared to conventional prostheses, though with the potential issue of paravalvular leak, which requires close follow-up. We present this case report describing the successful treatment of paravalvular leak in a 65 year old man, who had NYHA class III symptoms post implantation of a 21 mm Intuity Elite rapid deployment bioprosthesis (Edwards Lifesciences, Irvine, CA). Diagnosis was established using TTE, TOE, and Cardiac MRI. Performing balloon dilatation using an Atlas Gold balloon (BARD Peripheral Vascular Inc., Tempe, AZ) treated the likely inadequate expansion of the subvalvular stent, leading to significant reduction in the paravalvular leak. At one month follow-up patient reported complete resolution of his symptoms. Successful percutaneous treatment of paravalvular leak following implantation of rapid deployment sutureless bioprosthesis provides a new treatment strategy for these patients; this strategy requires further validation.
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Affiliation(s)
- Nikhil Pal
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Dylan Jones
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Gregory Rice
- Cardiothoracic Surgery Unit, Flinders Medical Centre, Adelaide, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia.,Department of Cardiology, College of Medicine and Public Health, Flinders University
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28
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Abstract
Aortic valve replacement has stood the test of time but is no longer an operation that is exclusively approached through a median sternotomy using only sutured prostheses. Currently, surgical aortic valve replacement can be performed through a number of minimally invasive approaches employing conventional mechanical or bioprostheses as well as sutureless valves. In either case, the direct surgical access allows inspection of the valve, complete excision of the diseased leaflets, and debridement of the annulus in a controlled and thorough manner under visual control. It can be employed to treat aortic valve pathologies of all natures and aetiologies. When compared with transcatheter valves in patients with a high or intermediate preoperative predictive risk, conventional surgery has not been shown to be inferior to transcatheter valve implants. As our understanding of sutureless valves and their applicability to minimally invasive surgery advances, the invasiveness and trauma of surgery can be reduced and outcomes can improve. This warrants further comparative trials comparing sutureless and transcatheter valves.
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Affiliation(s)
- Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
| | - Khalid Alkhamees
- Department of Cardiac Surgery, Prince Sultan Cardiac Center Al Hassa, Prince Fawaz bin Abdulaziz St., Hofuf city, 31982, Saudi Arabia
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
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29
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Roselli EE, Suri RM. Commentary: The unspoken truth about ease of use. J Thorac Cardiovasc Surg 2019; 159:443-444. [PMID: 31053432 DOI: 10.1016/j.jtcvs.2019.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Eric E Roselli
- Aortic Valve Center, Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic, Abu Dhabi, United Arab Emirates.
| | - Rakesh M Suri
- Aortic Valve Center, Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic, Abu Dhabi, United Arab Emirates
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30
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Noly PE, Maltais S. Commentary: If you want to make everyone happy, sell ice cream! Can faster sometimes mean better? J Thorac Cardiovasc Surg 2019; 159:445-446. [PMID: 31029448 DOI: 10.1016/j.jtcvs.2019.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Pierre-Emmanuel Noly
- Department of Cardiac Surgery, Montreal Heart Institute, Montréal, Québec, Canada
| | - Simon Maltais
- Department of Cardiac Surgery, Centre Hospitalié de l'Université de Montréal, Montréal, Québec, Canada.
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