Sutureless Versus Stented Valve in Aortic Valve Replacement in Patients With Small Annulus

Shalabi, Amjad; Spiegelstein, Dan; Sternik, Leonid; Feinberg, Micha S.; Kogan, Alexander; Levin, Shany; Orlov, Boris; Nachum, Eyal; Lipey, Alexander; Raanani, Ehud

doi:10.1016/j.athoracsur.2016.01.003

Cited by 44 publications

(59 citation statements)

References 23 publications

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“…3,4 The theoretical advantages of RD valves include a short surgery time, the ease of insertion even in limited operating fields, and their optimal hemodynamic properties. 3,5 However, whether the RD valves are truly beneficial is controversial. 6,7 Therefore, this meta-analysis was conducted to compare the early and follow-up outcomes of AVR using RD valves with conventional bioprosthetic AVR.…”

Section: See Editorial Commentary Page 2413mentioning

confidence: 99%

Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: A meta-analysis

Sohn

Jang

Hwang

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Section: See Editorial Commentary Page 2413mentioning

confidence: 99%

Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: A meta-analysis

Sohn

Jang

Hwang

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Valve underexpansion has been shown to distort the configuration of the leaflets 38, 51 and can affect transvalvular gradients and effective orifice areas 2, 16, 19, 21–23, 29, 48 . ViV with small SAVs, which already have a small EOA, put patients at higher risk of patient-prosthesis mismatch where the EOA is too small in relation to the patient’s body size 34 and 28 . The ViV configuration is also believed to affect leaflet durability by two primary mechanisms: 1) overhanging of the leaflets over the stent during opening and 2) twisting and overhanging of the leaflets over each other during valve closure 7, 16, 47 .…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Valve Underexpansion Limits Leaflet Durability: Implications for Valve-in-Valve Procedures

Martin

Sun

2016

Ann Biomed Eng

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Transcatheter aortic valve (TAV) implantation within a failed bioprosthetic valve is a growing trend for high-risk patients. The non-compliant stent of the previous prosthesis may prevent full expansion of the TAV, which has been shown to distort the leaflet configuration, and has been hypothesized to adversely affect durability. In this study, TAV leaflet fatigue damage under cyclic pressurization in the setting of stent underexpansion by 0 (fully expanded), 1, 2 and 3 mm was simulated using finite element analysis to test this hypothesis. In the 2 and 3 mm underexpanded devices, the TAV leaflets exhibited severe pin-wheeling during valve closure, which increased leaflet stresses dramatically, and resulted in accelerated fatigue damage of the leaflets. The leaflet fatigue damage in the 1 mm underexpanded case was similar to that in the fully expanded case. Clinically a range of 10% to 15% underexpansion is generally considered acceptable; however, it was observed in this study that ≥2 mm (≥9.1%) underexpansion, will significantly impact device durability. Further study is necessary to determine the impact of various deployment conditions, i.e. non-uniform and non-circular deployments and different implantation heights, on differing TAV devices, but it is clear that the normal TAV leaflet configuration must be preserved in order to preserve durability.

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“…It could be speculated that the nitinol struts might be responsible of increased transvalvular gradients 33 recently demonstrated the satisfying performance of the S size Perceval sutureless bioprosthesis either at discharge or at early follow-up, further validating the excellent hemodynamic performance of the sutureless bioprosthesis in patient with small aortic annuli. 31,32 These results suggest that the reliability of Perceval sutureless bioprosthesis even in patients with a small aortic annulus, or when a PPM could be anticipated preoperatively.…”

Section: Discussionmentioning

confidence: 81%

“…Interestingly, they recorded significantly greater EOA in the sutureless valve prosthesis group (1.5 ± 0.3 vs 1.1 ± 0.5 cm 2 ; P = .002) . Furthermore, Shalabi demonstrated that the Perceval sutureless bioprosthesis is associated with improved hemodynamic performance when compared to stented valves in a selected group of elderly patients with annular diameter ≤21 mm (peak gradients, 15 ± 7 vs 20 ± 11 mm Hg, P = .02; EOAi, 1.12 ± 0.2 vs 0.82 ± 0.1 cm 2 /m 2 , P < .05) …”

Section: Discussionmentioning

confidence: 97%

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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Sutureless Versus Stented Valve in Aortic Valve Replacement in Patients With Small Annulus

Cited by 44 publications

References 23 publications

Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: A meta-analysis

Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: A meta-analysis

Transcatheter Valve Underexpansion Limits Leaflet Durability: Implications for Valve-in-Valve Procedures

Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

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