Mid-term Results of First Experience in Sutureless Aortic Valve Replacement in Iran

Abstract

Background: Although the TAVI technique has been widespread in Europe and America, concerns have emerged regarding the associated complications, mainly paravalvular leakage, vascular complications, stroke, post-operative pacemaker implantation due to complete AV block, optimal access sites, long-term valve durability, and economic sustainability, therefore controversy remains about the ideal treatment of high-risk operable patients. Sutureless tissue valves like Perceval S may be a good option for these high risk operable patients. We will present the clinical outcomes of first cases of Perceval S in Iranian patients. Methods: From July 2015 to August 2016, 11 patients (8 male, 3 female) with severe aortic stenosis who were candidates for aortic valve replacement were included in this study. The mean age of patients was 73 ± 8 ranged from 65 to 86 years. The most common presenting symptom was dyspnea and three of the patients had coronary artery disease in need for concomitant revascularization. Preoperative peak gradient across the aortic valve ranged from 72 to 135 mmHg (mean = 97 ± 25). All patients were followed up from 3 to 20 months with a median of 13 months. Results: Dramatic reduction of trans-aortic peak gradients was seen in all patient (mean postoperative gradient = 29 ± 8 mmHg). Small degrees of transvalvular and paravalvular leakage were seen in intraoperative echocardiographies but only one patient had small asymptomatic paravalvular leakage during midterm follow up. Two patients need for transient pace maker; however we had no case of complete heart block. Mean post-operative mediastinal bleeding was 480 ± 150 mL and no patient needed re-exploration for bleeding or tamponade management. ICU stay time was 3 ± 1.54 days, and there was no in-hospital mortality. All patients were discharged in good status and there was no mortality during follow-up period. Conclusions: Preliminary clinical results of the first experience was encouraging; however we need to continue the study with more study volume, more follow up period and more high risk or complicated patients.

Highlights from the First Bi-monthly Virtual Meeting of Iranian Society of Cardiac Surgeons During COVID-19 Outbreak

“…Favorable reports have been reported with sutureless Perceval (LivaNova, London, United Kingdom) bioprosthesis in recent years (6). Minimally invasive approaches could be a good alternative for aortic valve replacement (AVR) in high risk patients especially when transcatheter aortic valve implantation (TAVI) is not feasible.…”