Comparison of the Performance of a Sutureless Bioprosthesis With Two Pericardial Stented Valves on Small Annuli: An In Vitro Study

Tasca, Giordano; Vismara, Riccardo; Mangini, Andrea; Romagnoni, Claudia; Contino, Monica; Redaelli, Alberto; Fiore, Gianfranco Beniamino; Antona, Carlo

doi:10.1016/j.athoracsur.2016.05.089

Cited by 20 publications

(15 citation statements)

References 17 publications

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“…In vitro studies demonstrated superiority of RPD compared with conventional bioprostheses (Crown PRT, Edwards Perimount Magna, and Magna Ease) in terms of hemodynamic performance. 8,9 In this real-world experience, larger prosthesis size did not translate into improved mean gradients at rest. Nevertheless, elderly patients with small aortic annuli could benefit from the use of RPD through faster implantation and less need for aortic root enlargement.…”

Section: Prosthesis Size and Hemodynamic Outcomesmentioning

confidence: 67%

“…7 RPD are supposedly hemodynamically advantageous due to the absence of a suture ring with larger effective orifice areas, resulting in lower pressure gradients in vitro. 8,9 This theoretical advantage has not been investigated in clinical real-world studies so far. In this retrospective propensity score matched single-center study, we compare hemodynamic outcome of RPD with conventional aortic bioprostheses.…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic Comparison of Sutureless and Rapid-Deployment Valves with Conventional Bioprostheses

Gotzmann

Wilbring²,

Charitos

et al. 2019

Thorac Cardiovasc Surg

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Background Sutureless and rapid-deployment bioprostheses (RPDs) are advantageous due to shorter aortic cross-clamp times (ACCs); however, few studies have investigated hemodynamic outcomes in comparison to conventional bioprostheses (CBs). Methods All patients receiving the Perceval (LivaNova, London, United Kingdom) and Intuity (Edwards Lifesciences, Irvine, California, United States) valves from February 2016 to December 2017 were included (n = 61). For controls, patients who underwent aortic valve replacement using CB from 2015 to 2018 (n = 743) were propensity-matched (n = 108). Primary end points were mean gradient at discharge, true internal diameter (ID) after implantation, and paravalvular leakage. Secondary end points were ACCs, cardiopulmonary bypass times (CPBTs), mortality, and pacemaker implantation. Results Age was 73.2 years (standard deviation [SD]: 7.6) in the RPD group and 72.9 years (SD: 7.3) in the CB group (p = 0.827). Median logistic EuroSCORE II was 3.4% (Q1: 2; IQ3: 5.3) and 3% (Q1: 1.9; IQ3: 5.6; p = 0.599). While ACCs and CPBT were shorter in RPDs (97 [SD: 31.4] vs. 125.4 minutes [SD: 62.1], p = 0.003; and 76.1 [SD: 25.7] vs. 89.7 minutes [SD: 34.3], p = 0.022), procedural times were similar (p = 0.257). True ID was 21.97 mm (SD: 1.79) in RPDs and 20.15 mm (SD: 1.70) in CB (p < 0.001).RPDs and CB resulted in comparable mean gradients (12.8 mm Hg [SD: 6.4] vs. 13.8 mm Hg [SD: 5.6]; p = 0.387) and rate of paravalvular regurgitation. There were no differences in the rates of pacemaker implantation and mortality.In a subanalysis of RPDs, mean gradient was 15.48 mm Hg (SD: 7.51) in Perceval (n = 21) and 10.79 mm Hg (SD: 4.78) in Intuity (n = 33; p = 0.010). Conclusions RPDs provided comparable hemodynamic performance, although implanted valves were larger in true ID. Whether this provides superior hemodynamic performance during exercise and longer durability needs further investigation. Among RPDs, the Intuity valve provided lower mean gradients at rest than Perceval valve.

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Section: Prosthesis Size and Hemodynamic Outcomesmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Hemodynamic Comparison of Sutureless and Rapid-Deployment Valves with Conventional Bioprostheses

Gotzmann

Wilbring²,

Charitos

et al. 2019

Thorac Cardiovasc Surg

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“…However, we recorded a mean transvalvular gradient of 12.6 ± 4.2 mm Hg at rest, with an EOA of 1.5 ± 0.5 cm 2 . Interestingly, Tasca et al . demonstrated that small size sutureless valve provided lowest gradients and larger EOA in an in vitro study, compared to two standard pericardial stented bioprostheses.…”

Section: Discussionmentioning

confidence: 99%

“…Tasca et al29 demonstrated that small size sutureless valve provided lowest gradients and larger EOA in an in vitro study, compared to two standard pericardial stented bioprostheses. These results have been confirmed clinically by Shresta et al,20 who observed a mean gradient of 13.6 ± 5.4 cm 2 and an EOA of 1.5 ± 0.25 cm 2 in a cohort of elderly patients with preoperative annulus ≤22 mm.…”

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confidence: 99%

Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

et al. 2017

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Objectives:The aim of this study was to evaluate the hemodynamic performance of a sutureless bioprosthesis under high workload at mid-term follow-up. Methods:Thirty-two patients who underwent isolated aortic valve replacement with a Perceval sutureless bioprosthesis with a minimum follow-up of 1 year were enrolled in this study. S size prosthesis was deployed in 10 patients (31.3%), M size in 9 (28.1%), L size in 8 (25%) and XL size in 5 (15.6%). Effective orifice area (EOA), EOA index (EOAi), and transvalvular gradients were assessed at rest and during dobutamine stress echocardiography (DSE) a median of 19.5 months after surgery.Results: Dobutamine stress echocardiography (DSE) significantly increased heart rate, stroke volume, ejection fraction, and transvalvular gradients (peak gradient, 24.0 ± 7.6 vs 38.7 ± 13.6 mm Hg, P < .001; mean gradient, 12.6 ± 4.2 vs 19.8 ± 8.3, P < .001).When compared to baseline, estimated valve areas significantly increased at follow-up (EOA, 1.48 ± 0.46 vs 2.06 ± 0.67, P < .001; EOAi, 0.84 ± 0.26 vs 1.17 ± 0.37, P < .001).Mean percentage increase in EOAi was 40.3% ± 28.0%. S size prostheses had the highest increase in EOA1, but the difference was not significant (S 46.0% ± 27.5% vs M 45.4% ± 34.5% vs L 32.7% ± 26.4% vs XL 32.1% ± 20.5%, P = .66). Severe patientprosthesis mismatch (EOAi ≤ 0.65 cm 2 /m 2 ) was present at rest in 8 patients (25%), but only in one patient (3.1%) during DSE. Conclusions:The Perceval sutureless bioprosthesis demonstrated good hemodynamics at rest and under high workload. The significant increase in EOAi during DSE suggests the potential advantages of Perceval sutureless bioprostheses in case of small aortic annulus or when patient-prosthesis mismatch is anticipated. K E Y W O R D Saortic valve prosthesis, aortic valve replacement, dobutamine stress echocardiography, sutureless

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“…These prostheses are intended to combine the advantages of conventional surgery-the controlled, complete removal of the degenerated native valve, the safety and the control of possible complications, and the long durability of the prostheses made from bovine pericardium-and of transcatheter techniques (fast implantation, less invasive access). Hemodynamics are generally rated better thanks to the smaller stent frame (24). Rapid deployment prostheses were initially recommended as therapeutic alternatives to conventional bioprostheses (25).…”

Section: Advantages and Disadvantagesmentioning

confidence: 99%

The Use of Biological Heart Valves: Types of Prosthesis, Durability and Complications

Kueri¹,

Kari²,

Fuentes³

et al. 2019

Deutsches Ärzteblatt International

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Background: Biological heart-valve prostheses have undergone continuous development up to the present, and technological advances have been made in catheterassisted valve systems (transcatheter aortic valve implantation, TAVI) and minimally invasive routes of application. These parallel trends have led to major changes in therapeutic strategies, widening the spectrum of patients who are candidates for biological aortic valve implantation. Methods: This review is based on pertinent publications retrieved by a systematic search in PubMed employing the search terms "conventional biological aortic prosthesis," "rapid deployment prosthesis," and "transcatheter aortic valve implantation/ replacement." Results: Among biological heart-valve prostheses, a distinction is drawn between stented (conventional, rapid-deployment, and catheter-assisted) and non-stented types. The long-term durability of conventional, surgically implantable biological valve protheses is by far the best documented: the reported 5-year reoperation rates range from 13.4% to 36.6%, and the pacemaker implantation rate is ca. 4%. Rapid-deployment prostheses combine the advantages of conventional and catheter-assisted techniques and facilitate minimally invasive approaches. The TAVI method is currently recommended for high-and intermediate-risk patients, while conventional valve replacement remains the method of choice for those at low risk. Rapid-deployment and TAVI prostheses is associated with a higher pacemaker implantation rate than conventional prostheses: these rates are 8.5-15.3% for TAVI and 6.0-8.8% for rapid-deployment valves. The intermediate-term durability of catheter-assisted and rapid-deployment prostheses appears promising, but their long-term durability is still unclear. Conclusion: The further development of biological heart-valve prostheses in the form of improved conventional, transcatheter, and rapid-deployment prostheses now enables individualized treatment. Before any such procedure is performed, the cardiac team must assess the patient's risk profile and the advantages and disadvantages of each type of prosthesis to determine which is best.

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Comparison of the Performance of a Sutureless Bioprosthesis With Two Pericardial Stented Valves on Small Annuli: An In Vitro Study

Cited by 20 publications

References 17 publications

Hemodynamic Comparison of Sutureless and Rapid-Deployment Valves with Conventional Bioprostheses

Hemodynamic Comparison of Sutureless and Rapid-Deployment Valves with Conventional Bioprostheses

Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

The Use of Biological Heart Valves: Types of Prosthesis, Durability and Complications

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