Right anterior mini-thoracotomy and sutureless valves: the perfect marriage

Solinas, Marco; Bianchi, Giacomo; Chiaramonti, Francesca; Margaryan, Rafik; Kallushi, Enkel; Gasbarri, Tommaso; Santarelli, Filippo; Murzi, Michele; Farneti, Pier Andrea; Leone, Alessandro; Simeoni, Simone; Varone, Egidio; Marchi, F; Glauber, Mattia; Concistrè, Giovanni

doi:10.21037/acs-2019-surd-172

Cited by 28 publications

(29 citation statements)

References 28 publications

(25 reference statements)

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“…Surgical aortic valve replacement (SAVR) with the sutureless self-expanding Perceval aortic bioprosthesis (LivaNova Group, Milan, Italy) was developed to combine the advantages of the transcatheter aortic valve replacement (TAVR) procedure, allowing for a fast implantation with no need for suturing, with the benefits of a conventional surgical approach owing to the possibility of removing the native valve along with the calcifications. The valve has grown in popularity mostly due to the reduced cardiopulmonary bypass (CPB) time ( 1 ), the improved myocardial recovery time and its application in minimally invasive cardiac surgery (MICS) procedures ( 2 ). In addition, the three PARTNER clinical trials' ( 3 – 5 ), the SURTAVI trial ( 6 ) and other observational cohort studies ( 7 , 8 ) have evidenced the non-inferiority of TAVR vs. SAVR.…”

Section: Introductionmentioning

confidence: 99%

Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis

Dokollari

Ramlawi

Torregrossa

et al. 2022

Front. Cardiovasc. Med.

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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.

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Section: Introductionmentioning

confidence: 99%

Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis

Dokollari

Ramlawi

Torregrossa

et al. 2022

Front. Cardiovasc. Med.

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“…In particular, when compared to surgical AVR, these devices also allow for shorter CPB and cross-clamp times (4,5). However, SBs and RDBs provide clear-cut advantages beyond the reduction of operative times, such as improved hemodynamic performance and the facilitation of mini-invasive approaches, which renders these devices competitive in specific cases, as well as in comparison with TAVI [ 3 , 6 , 37 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

Vendramin

Lechiancole

Piani

et al. 2021

JCDD

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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.

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“…Various studies have shown that RAMT AVR is associated with a low rate of postoperative complications and favorable midterm survival 19,23,24,36–46 . Our center established a minimally invasive surgical program dedicated to the sternum‐sparing RAMT approach in 2016.…”

Section: Discussionmentioning

confidence: 99%

“…Operative setup for the right anterior minithoracotomy (RAMT) approach. (B) Exposure of the aortic valve through a RAMT Various studies have shown that RAMT AVR is associated with a low rate of postoperative complications and favorable midterm survival 19,23,24,[36][37][38][39][40][41][42][43][44][45][46]. Our center established a minimally invasive…”

mentioning

confidence: 99%

Right anterior mini thoracotomy approach for isolated aortic valve replacement: Early outcomes at a Canadian center

Hassanabad

Aboelnazar

Maitland

et al. 2021

Journal of Cardiac Surgery

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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.

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Right anterior mini-thoracotomy and sutureless valves: the perfect marriage

Cited by 28 publications

References 28 publications

Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis

Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis

Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

Right anterior mini thoracotomy approach for isolated aortic valve replacement: Early outcomes at a Canadian center

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