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You are here: Contents > 2018-19 > Volume 27 Number 2 (2018-19) > AORTIC VALVE DISEASE > Sutureless Aortic Bioprosthesis in a Minithoracotomy Approach: Single-Center Experience with 400 Implants

Sutureless Aortic Bioprosthesis in a Minithoracotomy Approach: Single-Center Experience with 400 Implants

Giovanni Concistrè1,2, Francesca Chiaramonti1, Giacomo Bianchi1, Alfredo Giuseppe Cerillo1, Rafik Margaryan1, Filippo Santarelli1, Enkel Kallushi1, Marco Solinas1

1Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
2Electronic correspondence:

Background and aim of the study: Limited access reduces mortality and morbidity in patients referred for aortic valve replacement (AVR), and is facilitated by employing a sutureless technology. Herein is described the authors’ experience with the sutureless Perceval aortic bioprosthesis (LivaNova, Italy) in a right anterior minithoracotomy (RAMT) approach.

Methods: Between March 2011 and February 2016, a total of 631 patients (255 females, 376 males; mean age 77 ± 6 years; range: 65-89 years; mean EuroSCORE II 5.8 ± 6.5%) underwent AVR with a Perceval bioprosthesis. Of these patients, 400 (63%) were operated on via a RAMT approach in the second intercostal space. When considering only isolated AVR (n = 530), Perceval implantation via a RAMT approach was performed in 75.5% of patients. Aortic cannulation was performed directly in the ascending aorta, and venous drainage achieved with a percutaneous femoral venous cannula. Seven patients (1.75%) had previously undergone cardiac surgery. Prosthesis sizes implanted were: small (n = 57); medium (n = 128); large (n = 189); and extra-large (n = 26). Concomitant procedures included mitral valve surgery (n = 5), tricuspid valve repair (n = 1),

mitral valve repair (n = 1), tricuspid valve repair (n = 1), and myectomy (n = 2).

Results: The 30-day mortality was 0.7% (3/400). Cardiopulmonary bypass and aortic cross-clamp times were 82.3 ± 30.8 and 52 ± 21.6 min, respectively, for stand-alone procedures. Early moderate paravalvular leakage due to incomplete expansion of the sutureless valve occurred in two patients due to oversizing of the bioprosthesis, and required reoperation at two and nine postoperative days, respectively, using sutured aortic bioprosthesis implantation. Permanent pacemaker implantation within the first 30 days was necessary in 5% of patients. At a mean follow up of 16.6 ± 12.4 months, survival was 97.1%, freedom from reoperation 99.2%, and the mean transvalvular pressure gradient was 11.7 ± 5 mmHg.

Conclusion: AVR with a Perceval bioprosthesis via a RAMT approach is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance. A sutureless technology facilitates the RAMT approach.

The Journal of Heart Valve Disease 2018;27:127-134

Sutureless Aortic Bioprosthesis in a Minithoracotomy Approach: Single-Center Experience with 400 Implants

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