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Dokollari A, Torregrossa G, Bisleri G, Hassanabad AF, Sa MP, Sicouri S, Veshti A, Prifti E, Bacchi B, Cabrucci F, Ramlawi B, Bonacchi M. Early and Long-Term Clinical and Echocardiographic Outcomes of Sutureless vs. Sutured Bioprosthesis for Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:jcdd10050224. [PMID: 37233191 DOI: 10.3390/jcdd10050224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
Objective: The goal of this manuscript is to compare clinical and echocardiographic outcomes of patients undergoing aortic valve replacement (AVR) with Perceval sutureless bioprosthesis (SU-AVR) and sutured bioprosthesis (SB). Methods: Following the PRISMA statement, data were extracted from studies published after August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post-procedural permanent pacemaker implantation, and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop-out), need for a second transcatheter heart valve, 30-day mortality, stroke, and echocardiographic outcomes. Results: Twenty-one studies were included in the analysis. When SU-AVR was compared to other SB, mortality ranged from 0 to 6.4% for Perceval and 0 to 5.9% for SB. Incidence of PVL (Perceval 1-19.4% vs. SB 0-1%), PPI (Perceval 2-10.7% vs. SB 1.8-8.5%), and MI (Perceval 0-7.8% vs. SB 0-4.3%) were comparable. In addition, the stroke rate was lower in the SU-AVR group when compared to SB (Perceval 0-3.7% vs. SB 1.8-7.3%). In patients with a bicuspid aortic valve, the mortality rate was 0-4% and PVL incidence was 0-2.3%. Long-term survival ranged between 96.7 and 98.6%. Valve cost analysis was lower for the Perceval valve and higher for sutured bioprosthesis. Conclusions: Compared to SB valves, Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its non-inferior hemodynamics, implantation speed, reduced cardiopulmonary bypass time, reduced aortic cross-clamp time, and shorter length of stay.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | | | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| | - Michel Pompeu Sa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Altin Veshti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Edvin Prifti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Beatrice Bacchi
- St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Francesco Cabrucci
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Massimo Bonacchi
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
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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: 3] [Impact Index Per Article: 1.5] [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: 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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Villa E, Dalla Tomba M, Messina A, Trenta A, Brunelli F, Cirillo M, Mhagna Z, Chiariello GA, Troise G. Sutureless aortic valve replacement in high risk patients neutralizes expected worse hospital outcome: A clinical and economic analysis. Cardiol J 2018; 26:56-65. [PMID: 30234906 DOI: 10.5603/cj.a2018.0098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/01/2018] [Revised: 08/31/2018] [Accepted: 08/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aortic valve replacement (AVR) by sutureless prostheses is changing surgeon options, although which patients benefit most, as well as their possible economic impact is still to be defined. METHODS Perceval-S prosthesis (LivaNova) is reserved, at the documented Institution, for patients at perceived high surgical risk. This retrospective analysis of outcome and resource consumption compared Perceval with other tissue valves. To clarify the comparison, only patients respecting 'instructions-for- use' of Perceval were reviewed. INCLUSION CRITERIA > 65 years, +/- coronary artery bypass grafting, patent foramen ovale closure or myectomy. EXCLUSION CRITERIA bicuspid, combined valve or aortic sur- gery. Costs were calculated per patient on a daily basis including preoperative tests, operating costs (hourly basis), disposables, drugs, blood components and personnel. RESULTS The sutureless group (SU-AVR) had a higher risk profile than the sutured group (ST-AVR). Cardiopulmonary bypass (CPB) and cross-clamp times were significantly shorter in SU-AVR (isolated AVR: cross-clamp 52.9 ± 12.6 vs. 69 ± 15.3 min, p < 0.001; CPB 79.4 ± 20.3 vs. 92.7 ± 18.2 min, p < 0.001). Hospital mortality was 0.9% in SU-AVR and nil in ST-AVR, p = 0.489; intubation 7 (IQR 5-10.7) and 7 h (IQR 5-9), p = 0.785; intensive care unit 1 (IQR 1-1) and 1 day (IQR 1-1), p = 0.258; ward stay 5.5 (IQR 4-7) and 5 days (IQR 4-6), p = 0.002; pacemaker 5.7% (6/106) and 0.9% (1/109), p = 0.063, respectively. Hospital costs (excluding the prosthesis) were $12,825 (IQR 11,733-15,334) for SU-AVR and $12,386 (IQR 11,217-14,230) in ST-AVR, p = 0.055. CONCLUSIONS Despite higher operative risks in SU-AVR, hospital mortality, morbidity and resource consumption did not differ. Operative times were shorter with the sutureless device and this improve- ment, along with more frequent ministernotomy, may have improved many postoperative aims.
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Affiliation(s)
- Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
| | | | - Antonio Messina
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Andrea Trenta
- Administrative Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Federico Brunelli
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Cirillo
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Zean Mhagna
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Alfonso Chiariello
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy.,Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
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Li J, Shuai HY, Gylfe E, Tengholm A. Oscillations of sub-membrane ATP in glucose-stimulated beta cells depend on negative feedback from Ca(2+). Diabetologia 2013; 56:1577-86. [PMID: 23536115 PMCID: PMC3671113 DOI: 10.1007/s00125-013-2894-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Abstract
AIMS/HYPOTHESIS ATP links changes in glucose metabolism to electrical activity, Ca(2+) signalling and insulin secretion in pancreatic beta cells. There is evidence that beta cell metabolism oscillates, but little is known about ATP dynamics at the plasma membrane, where regulation of ion channels and exocytosis occur. METHODS The sub-plasma-membrane ATP concentration ([ATP]pm) was recorded in beta cells in intact mouse and human islets using total internal reflection microscopy and the fluorescent reporter Perceval. RESULTS Glucose dose-dependently increased [ATP]pm with half-maximal and maximal effects at 5.2 and 9 mmol/l, respectively. Additional elevations of glucose to 11 to 20 mmol/l promoted pronounced [ATP]pm oscillations that were synchronised between neighbouring beta cells. [ATP]pm increased further and the oscillations disappeared when voltage-dependent Ca(2+) influx was prevented. In contrast, K(+)-depolarisation induced prompt lowering of [ATP]pm. Simultaneous recordings of [ATP]pm and the sub-plasma-membrane Ca(2+) concentration ([Ca(2+)]pm) during the early glucose-induced response revealed that the initial [ATP]pm elevation preceded, and was temporarily interrupted by the rise of [Ca(2+)]pm. During subsequent glucose-induced oscillations, the increases of [Ca(2+)]pm correlated with lowering of [ATP]pm. CONCLUSIONS/INTERPRETATION In beta cells, glucose promotes pronounced oscillations of [ATP]pm, which depend on negative feedback from Ca(2+) . The bidirectional interplay between these messengers in the sub-membrane space generates the metabolic and ionic oscillations that underlie pulsatile insulin secretion.
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Affiliation(s)
- J. Li
- Department of Medical Cell Biology, Biomedical Centre, Uppsala University, Box 571, 75123 Uppsala, Sweden
| | - H. Y. Shuai
- Department of Medical Cell Biology, Biomedical Centre, Uppsala University, Box 571, 75123 Uppsala, Sweden
| | - E. Gylfe
- Department of Medical Cell Biology, Biomedical Centre, Uppsala University, Box 571, 75123 Uppsala, Sweden
| | - A. Tengholm
- Department of Medical Cell Biology, Biomedical Centre, Uppsala University, Box 571, 75123 Uppsala, Sweden
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