1
|
Im JE, Jung EY, Lee SS, Min HK. Right anterior mini-thoracotomy aortic valve replacement versus transcatheter aortic valve implantation in octogenarians: a single-center retrospective study. J Yeungnam Med Sci 2024; 41:96-102. [PMID: 38404057 DOI: 10.12701/jyms.2023.01228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The aim of this study was to compare the early outcomes of octogenarians undergoing minimally invasive right anterior mini-thoracotomy aortic valve replacement (RAT-AVR) with those undergoing transcatheter aortic valve implantation (TAVI) for aortic valve disease. METHODS In this single-center retrospective study, data were collected from octogenarians before and after RAT-AVR and TAVI between January 2021 and July 2022. Short-term outcomes, including the length of hospital stay, in-hospital mortality, all-cause mortality, and other major postoperative complications, were compared and analyzed. RESULTS There were no significant differences in in-hospital mortality, stroke, acute kidney dysfunction requiring renal replacement therapy, length of intensive care unit stay, or length of hospital stay. However, the TAVI group had a higher incidence of permanent pacemaker insertion (10% vs. 0%, p=0.54) and paravalvular leaks (75% vs. 0%, p<0.001). CONCLUSION In the present study on octogenarians, both TAVI and RAT-AVR showed comparable short-term results. Although both procedures were considered safe and effective in the selected group, RAT-AVR had a lower incidence of complete atrioventricular block and paravalvular regurgitation.
Collapse
Affiliation(s)
- Ji Eun Im
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Yeung Jung
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Seok Soo Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Ho-Ki Min
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
2
|
Awad AK, Ahmed A, Mathew DM, Varghese KS, Mathew SM, Khaja S, Newell PC, Okoh AK, Hirji S. Minimally invasive, surgical, and transcatheter aortic valve replacement: A network meta-analysis. J Cardiol 2024; 83:177-183. [PMID: 37611742 DOI: 10.1016/j.jjcc.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has evolved as an alternative to surgical aortic valve replacement (SAVR). In addition to full-sternotomy (FS), recent reports have shown successful minimally-invasive SAVR approaches, including mini-sternotomy (MS) and mini-thoracotomy (MT). This network-meta-analysis (NMA) seeks to provide an outcomes comparison based on these different modalities (MS, MT, TAVR) compared with FS as a reference arm for the management of aortic valve disease. METHODS A comprehensive literature search was performed to identify studies that compared minimally-invasive SAVR (MS/MT) to conventional FS-SAVR, and/or TAVR. Bayesian NMA was performed using the random effects model. Outcomes were pooled as risk ratios (RR) with their 95 % confidence intervals (CIs). Our primary outcomes included 30-day mortality, stroke, acute kidney injury (AKI), major bleeding, new permanent pacemaker (PPM), and paravalvular leak (PVL). We also assessed long-term mortality at the latest follow-up. RESULTS A total of 27,117 patients (56 studies) were included; 10,397 patients had FS SAVR, 9523 had MS, 5487 had MT, and 1710 had TAVR. Compared to FS, MS was associated with statistically-significantly lower rates of 30-day mortality (RR, 0.76, 95%CI 0.59-0.98), stroke (RR, 0.84, 95%CI 0.72-0.97), AKI (RR, 0.76, 95%CI 0.61-0.94), and long-term mortality (RR 0.84, 95%CI 0.72-0.97) at a weighted mean follow-up duration of 10.4 years, while MT showed statistically-significantly higher rates of 30-day PVL (RR, 3.76, 95%CI 1.31-10.85) and major bleeding (RR 1.45; 95%CI 1.08-1.94). TAVR had statistically significant lower rates of 30-day AKI (RR 0.49, 95%CI 0.31-0.77), but showed statistically-significantly higher PPM (RR 2.50; 95%CI 1.60-3.91) and 30-day PVL (RR 12.85, 95%CI 5.05-32.68) compared to FS. CONCLUSIONS MS was protective against 30-day mortality, stroke, AKI, and long-term mortality compared to FS; TAVR showed higher rates of 30-day PVL and PPM but was protective against AKI. Conversely, MT showed higher rates of 30-day PVL and major bleeding. With the emergence of TAVR, the appropriate benchmarks for SAVR comparison in future trials should be the minimally-invasive SAVR approaches to provide clinical equipoise.
Collapse
Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adham Ahmed
- City University of New York School of Medicine, New York, NY, USA
| | - Dave M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | | | - Serena M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | - Sofia Khaja
- City University of New York School of Medicine, New York, NY, USA
| | - Paige C Newell
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sameer Hirji
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
3
|
Tchana-Sato V, Bruls S, Minga Lowampa E, Houben A, Desiron Q, Hans G, Lagny MG, Jaquet O, Defraigne JO, Lavigne JP. Surgery of the ascending aorta via a right anterior minithoracotomy: initial surgical experience of a single center. Acta Chir Belg 2024; 124:28-34. [PMID: 36424303 DOI: 10.1080/00015458.2022.2152240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES Full median sternotomy (FMS) is the common surgical access for patients undergoing replacement of the ascending aorta (AA) with or without aortic valve replacement (AVR). The right anterior mini-thoracotomy (RAMT) approach has been increasingly adopted for AVR. This approach has been shown to decrease blood loss and hospital length of stay (LOS) compared with FMS. The RAMT approach may also be beneficial in selected patients requiring AA procedures with or without AVR. We present our initial clinical experience of patients who have undergone a RAMT for supracommissural replacement of the tubular AA with or without AVR. METHODS This is a single-center retrospective review of 10 patients who underwent an elective RAMT for replacement of the tubular AA with or without AVR between November 2019 and January 2022. Clinical outcomes evaluated include 30-day mortality, intensive care and hospital LOS, time to extubation, operative times, as well as postoperative complications such as stroke and bleeding. RESULTS Median cross-clamp and cardiopulmonary bypass times were 109 and 148 min, respectively. Median time to extubation was 2.5 h and median intensive care unit and hospital stay were 2 and 10 days, respectively. There were two re-thoracotomies for postoperative bleeding and two cases of sub-xiphoidal pericardial drainage for pericardial effusion. There were no strokes and no in-hospital nor 30-day mortalities. CONCLUSIONS The replacement of the AA with or without concomitant AVR can be performed through a RAMT in carefully selected patients. However, the safety of this approach, as compared to full/partial median sternotomy, remains to be proven.
Collapse
Affiliation(s)
| | - Samuel Bruls
- Department of Cardiovascular Surgery, CHU Liege, Liege, Belgium
| | | | - Alan Houben
- Department of Anesthesiology, CHU Liege, Liege, Belgium
| | - Quentin Desiron
- Department of Cardiovascular Surgery, CHU Liege, Liege, Belgium
| | - Gregory Hans
- Department of Anesthesiology, CHU Liege, Liege, Belgium
| | | | - Oceane Jaquet
- Department of Anesthesiology, CHU Liege, Liege, Belgium
| | | | | |
Collapse
|
4
|
Concistrè G, Bianchi G, Margaryan R, Zancanaro E, Chiaramonti F, Kallushi E, Gasbarri T, Murzi M, Varone E, Simeoni S, Leone A, Santarelli F, Farneti P, Solinas M. Ten-year experience with sutureless Perceval bioprosthesis: single-centre analysis in 1157 implants. J Cardiovasc Med (Hagerstown) 2023; 24:506-513. [PMID: 37115966 DOI: 10.2459/jcm.0000000000001475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIMS We describe long-term clinical and echocardiographic outcomes in the largest single-centre cohort of patients who underwent aortic valve replacement (AVR) with sutureless Perceval (CorCym, Italy) bioprosthesis. METHODS Between March 2011 and March 2021, 1157 patients underwent AVR with Perceval bioprosthesis implantation. Mean age was 77 ± 6 years (range: 46-89 years) and mean EuroSCORE II was 6.7 ± 3.2% (range: 1.7-14.2%). Concomitant procedures were performed in 266 patients (23%). RESULTS Thirty-day mortality was 1.38% (16/1157). Eight hundred and twenty of 891 (92%) isolated AVRs underwent minimally invasive surgery with a ministernotomy ( n = 196) or right minithoracotomy ( n = 624) approach. Cardiopulmonary bypass and aortic cross-clamp times were 81.1 ± 24.3 and 50.6 ± 11.7 min for isolated AVR and 144.5 ± 34.7 and 96.4 ± 21.6 min for combined procedures. At mean follow-up of 53.08 ± 6.7 months (range: 1-120.5 months), survival was 96.5% and mean transvalvular pressure gradient was 13.7 ± 5.8 mmHg. Left ventricular mass decreased from 152.8 to 116.1 g/m 2 ( P < 0.001) and moderate paravalvular leakage occurred in three patients without haemolysis not requiring any treatment. Freedom from reoperation was 97.6%. Eight patients required surgical reintervention and 19 patients transcatheter valve-in-valve procedure for structural prosthesis degeneration at a mean of 5.6 years after first operation (range: 2-9 years). CONCLUSION AVR with a Perceval bioprosthesis is associated with good clinical results and excellent haemodynamic performance in our 10-year experience. Structural degeneration rate of Perceval is comparable with other bioprosthetic aortic valves. Sutureless technology may reduce operative time especially in combined procedures and enable minimally invasive AVR.
Collapse
Affiliation(s)
- Giovanni Concistrè
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Elmously A, Lahan S, Al Abri Q, Wyler von Ballmoos MC, Ramchandani M. Sutureless Perceval Valve: Size Matters. Innovations�(Phila) 2023; 18:311-315. [PMID: 37585809 DOI: 10.1177/15569845231190881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Adham Elmously
- Department of Cardiovascular Surgery, Houston Methodist Hospital, DeBakey Heart and Vascular Center, TX, USA
| | - Shubham Lahan
- Department of Cardiovascular Surgery, Houston Methodist Hospital, DeBakey Heart and Vascular Center, TX, USA
| | - Qasim Al Abri
- Department of Cardiac Surgery, National Heart Center, Royal Hospital, Muscat, Oman
| | | | - Mahesh Ramchandani
- Department of Cardiovascular Surgery, Houston Methodist Hospital, DeBakey Heart and Vascular Center, TX, USA
| |
Collapse
|
6
|
Quinn RD. The 10 Commandments of Perceval Implantation. Innovations�(Phila) 2023; 18:299-307. [PMID: 37585810 DOI: 10.1177/15569845231191525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Reed D Quinn
- Cardiovascular Surgery, Maine Medical Center, Portland, ME, USA
| |
Collapse
|
7
|
Sonaglioni A, Grasso E, Nicolosi GL, Trevisan R, Martinelli GL, Lombardo M. An Unusual Case of Ascending Aorta Dissection 4 Years after Perceval Sutureless Bioprosthesis Implantation: Easier Access to Diagnosis through the Right Parasternal Longitudinal Echocardiographic Window. J Cardiovasc Echogr 2023; 33:98-101. [PMID: 37772053 PMCID: PMC10529284 DOI: 10.4103/jcecho.jcecho_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 09/30/2023] Open
Abstract
Sutureless bioprostheses are more frequently used for the surgical treatment of elderly patients with high burden of comorbidity, who are candidates to aortic valve replacement (AVR). Among the sutureless bioprostheses, the Perceval valve has shown a good midterm durability, with very few reports of valve deterioration and low risk of complications. Herein, we present an unusual case of ascending aorta dissection which occurred 4 years after AVR with a Perceval sutureless pericardial bioprosthesis, likely related to the peculiar prosthetic design. A high right parasternal longitudinal view of the aorta in the right lateral decubitus allowed to suspect the acute aortic syndrome, thus accelerating the subsequent diagnostic and therapeutic iter.
Collapse
Affiliation(s)
- Andrea Sonaglioni
- Division of Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Enzo Grasso
- Division of Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | | | - Roberta Trevisan
- Division of Radiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Gian Luca Martinelli
- Division of Cardiac Surgery, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Michele Lombardo
- Division of Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| |
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
9
|
Niinami H, Sawa Y, Shimokawa T, Domoto S, Nakamura Y, Sakaguchi T, Ito T, Toda K, Amano A, Gersak B. 1-year outcomes of patients implanted with the Perceval sutureless valve: the Japanese post-marketing surveillance study. Heart Vessels 2023; 38:949-956. [PMID: 36773041 DOI: 10.1007/s00380-023-02240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023]
Abstract
Sutureless offers an alternative to standard valves in surgical aortic valve replacement (SAVR). We sought to confirm the efficacy and safety of the Perceval sutureless valve in Japanese patients. Prospective observational study of 204 patients who underwent SAVR with Perceval at 19 sites in Japan between March and December 2019. The primary outcomes were 30-day mortality and postoperative complications; the secondary outcome was all-cause mortality at 1 year. Efficacy outcomes were changed in New York Heart Association (NYHA) class, pressure gradients, effective orifice area (EOA), EOA indexed to body surface area (EOAi) and severity of aortic regurgitation. Mean age was 77.7 years, 62.7% were female. Procedural success rate was 99.0%. The median cross-clamp and cardiopulmonary bypass times were 68.0 and 108 min. Perceval size S and M were implanted in 95 (46.6%) and in 76 (37.3%) of patients, respectively. The 30-day and late mortality rate were 0.5% and 4.4%, while the new permanent pacemaker implantation rate was 4.4%. Mean pressure gradient was 13.0 mmHg at discharge, reaching 11.0 mmHg at 1 year; while the mean EOA was 1.5 cm2 at discharge remaining stable up to 1 year. No moderate or severe leakages were present at discharge or at 1 year. NYHA class improved by ≥ 1 level in 55.1% of the patients at discharge and in 69.4% of the patients at 1 year. 1-year outcomes of SAVR with the Perceval sutureless valve in Japanese patients were favorable. This valve offers a promising alternative to conventional biological AVR in this Japanese population.
Collapse
Affiliation(s)
- Hiroshi Niinami
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University Tokyo, Tokyo, Japan.
| | - Yoshiki Sawa
- Cardiovascular Surgery, Osaka University, Suita, Japan
| | - Tomoki Shimokawa
- Cardiovascular Surgery, Sakakibara Heart Institute Tokyo/Teikyo University, Fuchu, Japan
| | - Satoru Domoto
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University Tokyo, Tokyo, Japan
| | | | - Taichi Sakaguchi
- Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Toshiaki Ito
- Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Koichi Toda
- Cardiovascular Surgery, Osaka University, Suita, Japan
| | - Atsushi Amano
- Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Borut Gersak
- Medical Faculty/Nisteri, Medicine and Research, University of Ljubljana, Phoenix, AZ, USA
| |
Collapse
|
10
|
Sá MP, Van den Eynde J, Erten O, Sicouri S, Ramlawi B. Sternal-sparing aortic valve replacement with sutureless valve in bicuspid valve. J Card Surg 2022; 37:5653-5662. [PMID: 36378946 DOI: 10.1111/jocs.17185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
Over the last decade, sutureless valves (Perceval, LivaNova PLC) were brought to the market as an alternative to stented valves for patients requiring surgical aortic valve replacement (SAVR). However, Perceval demands special steps for implantation, among which we can mention specific training for the surgical team members. Sternal-sparing cardiac procedures are conceived to limit surgical trauma, but the technical requirements and preoperative planning are more challenging than those for conventional sternotomy. SAVR is frequently carried out through an upper hemisternotomy, but the right anterior thoracotomy (RAT) represents an even less traumatic, technical advancement. In the context of SAVR with RAT, Perceval has been considered the "perfect marriage." In patients with bicuspid aortic valve (BAV), some surgeons initially avoided the Perceval valve but, with growing experience, the prosthesis has been used for a wide variety of indications. According to an international consensus statement recently published, there are 3 BAV types: the fused BAV, the 2-sinus BAV and the partial-fusion BAV, each with specific phenotypes. The 2-sinus BAV has 2 cusps, roughly equal in size and shape, each cusp occupying 180° of the annular circumference, with only 2 aortic sinuses, resulting in a 2-sinus/2-cusp valve without raphe and with 180° commissural angles. Since the elliptic aortic annulus in BAV patients poses a challenge for sutureless valves and the RAT approach has been increasingly adopted for minimally invasive SAVR, our description of the surgical technique focuses on the specific procedural details in the scenario of 2-sinus BAV laterolateral phenotype.
Collapse
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| |
Collapse
|
11
|
Nakamura Y, Narita T, Kuroda M, Nakayama T, Tsuruta R, Yoshiyama D, Yasumoto Y, Sawa S, Furutachi A, Ito Y. Sutureless Aortic Valve Replacement Through Lateral Mini-Thoracotomy - Feasibility and Effectiveness. Circ J 2022; 86:1733-1739. [PMID: 35896351 DOI: 10.1253/circj.cj-22-0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Minimally invasive sutureless aortic valve replacement with the Perceval bioprosthetic heart valve (MISUAVR) is commonly performed through a right anterior thoracotomy (AT). However, a lateral thoracotomy (LT) may be superior as it does not require rib and right internal thoracic artery (RITA) cutting.Methods and Results: In total, 38 MISUAVRs performed from May 2019 to approximately August 2021 were retrospectively reviewed; 21 through LT (Group L), and 17 through AT (Group A). In Group L, the skin incision was made on the right anterior axillary line and third intercostal space, and in group A, on the right anterior chest and second or third intercostal space. All other surgical techniques were the same. Age, body surface area, EuroSCORE II, and ejection fraction were similar between the patients. Cardiopulmonary bypass (L: 82±19 vs. A: 93±28 min, P=0.19) and cross-clamp times (L: 57±13, vs. A: 64±23 min, P=0.19) were similar. Rib and/or RITA cutting were required in 94.6% of patients in group A and in none of group L (P<0.001). Surgical visualization score was better in group L (L: 1.19±0.40 vs. A: 1.94±0.69, P<0.01). Total amount of intraoperative bleeding was lower in group L (L: 623±141 vs. A: 838±316 mL, P<0.01). Duration of hospital stay was similar (P=0.30). CONCLUSIONS MISUAVR through LT has multiple advantages over AT.
Collapse
Affiliation(s)
| | - Takuya Narita
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Shintaro Sawa
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Akira Furutachi
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chibanishi General Hospital
| |
Collapse
|
12
|
Matsunaga S, Ushijima T, Sonoda H, Shiose A. Redo Aortic Valve Replacement With Perceval Prosthesis via Minithoracotomy in a Patient With Permanent Tracheostoma and Tracheoesophageal Shunt. Innovations (Phila) 2022; 17:352-354. [PMID: 35786016 DOI: 10.1177/15569845221106758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 76-year-old male patient had undergone aortic valve replacement with a 19-mm Carpentier-Edwards Perimount valve 12 years prior and underwent laryngopharyngo-esophagectomy for hypopharyngeal carcinoma followed by permanent tracheostomy and tracheoesophageal shunt creation 2 years later. Echocardiography showed exacerbated structural valve deterioration of the bioprosthesis, necessitating redo surgery. A permanent tracheostoma, located just above the upper edge of the sternum, seemed to be at high risk of serious infections when median resternotomy was performed. To minimize the risk of infection, we performed implantation of a Perceval prosthesis via the right anterior minithoracotomy after sufficient anatomical assessments. There was no evidence of mediastinitis or wound infection during the follow-up period. This report highlights that the less invasive Perceval implantation strategically allowed reduction in the resternotomy-associated infection risks in this patient.
Collapse
Affiliation(s)
- Shogo Matsunaga
- Department of Cardiovascular Surgery, 145181Kyushu University Hospital, Fukuoka, Japan
| | - Tomoki Ushijima
- Department of Cardiovascular Surgery, 145181Kyushu University Hospital, Fukuoka, Japan
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, 145181Kyushu University Hospital, Fukuoka, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, 145181Kyushu University Hospital, Fukuoka, Japan
| |
Collapse
|
13
|
Fischlein T, Caporali E, Asch FM, Vogt F, Pollari F, Folliguet T, Kappert U, Meuris B, Shrestha ML, Roselli EE, Bonaros N, Fabre O, Corbi P, Troise G, Andreas M, Pinaud F, Pfeiffer S, Kueri S, Tan E, Voisine P, Girdauskas E, Rega F, García-Puente J, De Kerchove L, Lorusso R. Hemodynamic Performance of Sutureless vs. Conventional Bioprostheses for Aortic Valve Replacement: The 1-Year Core-Lab Results of the Randomized PERSIST-AVR Trial. Front Cardiovasc Med 2022; 9:844876. [PMID: 35252408 PMCID: PMC8894864 DOI: 10.3389/fcvm.2022.844876] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveSutureless aortic valves are an effective option for aortic valve replacement (AVR) showing non-inferiority to standard stented aortic valves for major cardiovascular and cerebral events at 1-year. We report the 1-year hemodynamic performance of the sutureless prostheses compared with standard aortic valves, assessed by a dedicated echocardiographic core lab.MethodsPerceval Sutureless Implant vs. Standard Aortic Valve Replacement (PERSIST-AVR) is a prospective, randomized, adaptive, open-label trial. Patients undergoing AVR, as an isolated or combined procedure, were randomized to receive a sutureless [sutureless aortic valve replacement (Su-AVR)] (n = 407) or a stented sutured [surgical AVR (SAVR)] (n = 412) bioprostheses. Site-reported echocardiographic examinations were collected at 1 year. In addition, a subgroup of the trial population (Su-AVR n = 71, SAVR = 82) had a complete echocardiographic examination independently assessed by a Core Lab (MedStar Health Research Institute, Washington D.C., USA) for the evaluation of the hemodynamic performance.ResultsThe site-reported hemodynamic data of stented valves and sutureless valves are stable and comparable during follow-up, showing stable reduction of mean and peak pressure gradients through one-year follow-up (mean: 12.1 ± 6.2 vs. 11.5 ± 4.6 mmHg; peak: 21.3 ± 11.4 vs. 22.0 ± 8.9 mmHg). These results at 1-year are confirmed in the subgroup by the core-lab assessed echocardiogram with an average mean and peak gradient of 12.8 ± 5.7 and 21.5 ± 9.1 mmHg for Su-AVR, and 13.4 ± 7.7 and 23.0 ± 13.0 mmHg for SAVR. The valve effective orifice area was 1.3 ± 0.4 and 1.4 ± 0.4 cm2 at 1-year for Su-AVR and SAVR. These improvements are observed across all valve sizes. At 1-year evaluation, 91.3% (n = 42) of patients in Su-AVR and 82.3% in SAVR (n = 51) groups were free from paravalvular leak (PVL). The rate of mild PVL was 4.3% (n = 2) in Su-AVR and 12.9% (n = 8) in the SAVR group. A similar trend is observed for central leak occurrence in both core-lab assessed echo groups.ConclusionAt 1-year of follow-up of a PERSIST-AVR patient sub-group, the study showed comparable hemodynamic performance in the sutureless and the stented-valve groups, confirmed by independent echo core lab. Perceval sutureless prosthesis provides optimal sealing at the annulus with equivalent PVL and central regurgitation extent rates compared to sutured valves. Sutureless valves are therefore a reliable and essential technology within the modern therapeutic possibilities to treat aortic valve disease.
Collapse
Affiliation(s)
- Theodor Fischlein
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
- *Correspondence: Theodor Fischlein
| | - Elena Caporali
- Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Department of Cardiac Surgery, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
- Elena Caporali
| | - Federico M. Asch
- MedStar Health Research Institute, Washington Hospital Center, Washington D.C., DC, United States
| | - Ferdinand Vogt
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Thierry Folliguet
- Cardiac Surgery Unit, Hôpital Henri Mondor, Université Paris 12, Créteil, France
| | - Utz Kappert
- Herzzentrum Dresden GmbH Universitätsklinik, Dresden, Germany
| | - Bart Meuris
- Cardiac Surgery Unit, UZ Gasthuisberg Leuven, Leuven, Belgium
| | - Malakh L. Shrestha
- Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Eric E. Roselli
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Olivier Fabre
- Lens Hospital and Bois Bernard Private Hospital, Lens, France
| | | | - Giovanni Troise
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Frederic Pinaud
- Department of Cardiac Surgery, University Hospital Angers, Angers, France
| | - Steffen Pfeiffer
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Sami Kueri
- University Heart Center Freiburg, Bad Krozingen, Germany
| | - Erwin Tan
- Catharina Ziekenhuis, Eindhoven, Netherlands
| | - Pierre Voisine
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, QC, Canada
| | - Evaldas Girdauskas
- University Heart Center Hamburg, Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg, Germany
| | - Filip Rega
- Cardiac Surgery Unit, UZ Gasthuisberg Leuven, Leuven, Belgium
| | | | | | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
- Cardiac Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| |
Collapse
|
14
|
Dokollari A, Ramlawi B, Torregrossa G, Sá MP, Sicouri S, Prifti E, Gelsomino S, Bonacchi M. Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis. Front Cardiovasc Med 2022; 8:789392. [PMID: 35071358 PMCID: PMC8766961 DOI: 10.3389/fcvm.2021.789392] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/29/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: To highlight the main target points covered by clinical studies on the Perceval sutureless valve for surgical aortic valve replacement (SAVR) and raise a point of discussion for further expansion of its use when compared with stented bioprostheses (SB) and transcatheter aortic valve replacement (TAVR). Methods: We reviewed clinical trials and retrospective studies published up to date and compared the outcomes in terms of mortality, myocardial infarction (MI) stroke, paravalvular leak (PVL), permanent pacemaker implantation (PPI), bleeding and long-term outcomes. Results: Clinical studies showed that 30-day mortality ranged from 0–4% for Perceval and 2.9–7% for TAVR. The incidence of PVL (Perceval 1.9–19.4 vs. TAVR 9–53.5%), PPI (Perceval 2–11.2 vs. TAVR 4.9–25.5%), stroke (Perceval 0 vs. TAVR 0–2.8%), MI (Perceval 0 vs. TAVR 0–3.5%), were all higher in the TAVR group. Compared to other SB, mortality ranged from 0–6.4% for Perceval and 0–5.9% for SB. The incidence of PVR (Perceval 1–19.4 vs. SB 0–1%), PPI (Perceval 2–10.7 vs. SB 1.8–8.5%), stroke (Perceval 0–3.7 vs. SB 1.8–7.3%) and MI (Perceval 0–7.8 vs. SB 0–4.3%) were comparable among the groups. In patients with a bicuspid aortic valve, mortality rate was (0–4%) and PVL incidence was (0–2.3%). However, there was a high incidence of PPI (0–20%), and stroke (0–8%). Long-term survival ranged between 96.7–98.6%. Conclusions: The Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its implantation speed, the reduced cardiopulmonary bypass time, the reduced aortic cross-clamp time and the shorter intensive care unit and hospital length of stay.
Collapse
Affiliation(s)
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Edvin Prifti
- Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Sandro Gelsomino
- Department of Cardiac Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, Netherlands
| | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
15
|
Pollari F, Fischlein T. „Rapid-deployment“-Prothesen im Zeitalter der Transkatheter-Aortenklappenimplantation. Z Herz- Thorax- Gefäßchir 2021. [DOI: 10.1007/s00398-021-00452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Vendramin I, Lechiancole A, Piani D, Nucifora G, Benedetti G, Sponga S, Muser D, Bortolotti U, Livi U. Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations. J Cardiovasc Dev Dis 2021; 8:74. [PMID: 34201997 DOI: 10.3390/jcdd8070074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
Collapse
|
17
|
Fatehi Hassanabad A, Aboelnazar N, Maitland A, Holloway DD, Adams C, Kent WDT. Right anterior mini thoracotomy approach for isolated aortic valve replacement: Early outcomes at a Canadian center. J Card Surg 2021; 36:2365-2372. [PMID: 34002895 DOI: 10.1111/jocs.15571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The goal of this manuscript was to report the clinical outcomes of the initial series of 100 consecutive Right Anterior Mini Thoracotomy (RAMT) aortic valve replacement (AVR) implantations at a Canadian Center. METHODS This retrospective study reported the clinical outcomes of the first 100 patients who underwent the RAMT approach for isolated surgical AVR in Calgary, Canada, between 2016 and 2020. Primary outcomes were death within 30 days of surgery and disabling stroke. Secondary outcomes included surgical times, the need for permanent pacemaker (PPM), incidence of postoperative blood transfusion in the intensive care unit (ICU), postsurgical atrial fibrillation (AF), length of ICU/hospital stay, postsurgical AF, residual paravalvular leak (PVL), postoperative transvalvular gradient, need for postsurgical intravenous opioids, duration of invasive ventilation in the ICU, and chest tube output in the first 12 h postsurgery. RESULTS In this study, 54 patients were male, and the average age of the cohort was 72 years. Mortality within 30 days of surgery was 1% with no disabling postoperative strokes. Mean cardiopulmonary bypass and cross clamp was 84 and 55 min, respectively. PPM rate was 3%, incidence of blood transfusion in the ICU was 4%, and the rate of postoperative AF was 23%. Median length of ICU and hospital stay was 1 and 5 days, respectively. Rate of mild or greater residual PVL was 3%, while the average residual transvalvular mean gradient was 8.5 mmHg. CONCLUSION The sternum-sparing RAMT approach can be safely integrated into surgical practice as a minimally invasive alternative for isolated AVR, and can reduce postoperative bleeding and narcotic requirements.
Collapse
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nader Aboelnazar
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Andrew Maitland
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel D Holloway
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - William D T Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|