The Perceval S Aortic Valve Has the Potential of Shortening Surgical Time: Does It Also Result in Improved Outcome?

Santarpino, Giuseppe; Pfeiffer, Steffen; Concistrè, Giovanni; Großmann, I.; Hinzmann, Martin; Fischlein, Theodor

doi:10.1016/j.athoracsur.2013.03.083

Cited by 115 publications

(107 citation statements)

References 15 publications

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“…In addition, no formal costeffectiveness analysis was conducted to compare the costs (currently higher than those of traditional prosthetic valves) and benefits of Perceval S aortic valve implantation. Notwithstanding this, it may be speculated that the better clinical outcomes by using a minimally invasive approach and the Perceval S bioprosthesis [19] may compensate for hospital acquisition costs, as Perceval S implantation results in shorter ICU/ward stay and ventilation time and less blood transfusions. However, further studies are warranted to assess the cost-effectiveness of this bioprosthesis.…”

Section: Discussionmentioning

confidence: 99%

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Left ventricular mass regression after sutureless implantation of the Perceval S aortic valve bioprosthesis: Preliminary results

Santarpino¹,

Pfeiffer²,

Concistrè³

et al. 2013

Thorac cardiovasc Surg

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OBJECTIVES: Left ventricular (LV) hypertrophy in aortic stenosis (AS) is considered a compensatory response helping maintain systolic function, but constitutes a risk factor for cardiac morbidity and mortality. The aim of this study was to assess the degree of LV mass regression after sutureless implantation of the Perceval S aortic valve bioprosthesis (Sorin Group, Saluggia, Italy). METHODS:Between March 2010 and July 2012, 78 patients with symptomatic AS underwent isolated aortic valve replacement (AVR) with the Perceval bioprosthesis. Mean age was 77.1 ± 5.3 years, 46 patients were female (59%) and mean logistic EuroSCORE was 11 ± 7.5%. Echocardiography was performed preoperatively, at discharge, and at follow-up (mean 13.5 ± 7.3 months). LV mass was calculated using the Devereux formula and indexed to body surface area. RESULTS:There was 1 in-hospital non-cardiac death and 3 late deaths. LV mass index decreased from 148.4 ± 46 g/m 2 at baseline to 119.7 ± 38.5 g/m 2 at follow-up (P = 0.002). No significant changes were observed in LV hypertrophy and/or relative wall thickness >0.42 as well as in LV ejection fraction. Mean aortic gradient decreased from 49.5 ± 15.8 mmHg at baseline to 11.6 ± 5.1 mmHg at discharge and 8.3 ± 4.4 mmHg at follow-up (P < 0.001), resulting in significant clinical improvement. No moderate or severe paravalvular leakage was observed at discharge and at follow-up. CONCLUSIONS:In AS patients, isolated AVR with the Perceval sutureless bioprosthesis is associated with significant LV mass regression at 1-year follow-up. However, longer-term follow-up is necessary to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, 83.3% of patients had a history of hypertension. Despite optimal medical treatment, reduced systemic arterial compliance may have contributed to incomplete LV mass regression [19]. Finally, genetic factors may have played a role [20].…”

Section: Discussionmentioning

confidence: 99%

Left ventricular mass regression after sutureless implantation of the Perceval S aortic valve bioprosthesis: Preliminary results

Santarpino¹,

Pfeiffer²,

Concistrè³

et al. 2013

Thorac cardiovasc Surg

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“…SU-AVR using a stented bioprosthetic valve offers significant reductions in both CPB and aortic cross-clamp times, which may potentially lead to improved outcome [6]. In contrast to transcatheter aortic valve replacement (TAVI), SU-AVR is performed after valve excision and results in optimal hemodynamic performance in terms of the effective valve orifice area and similar early and long-term complication rates compared to conventional aortic valve replacement requiring annular sutures [2].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative paravalvular leakage after sutureless aortic valve replacement corrected with secondary balloon dilatation -A case report-

et al. 2016

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Sutureless aortic valve replacement was performed in a 72-year-old female patient with severe aortic stenosis who had undergone coronary revascularization and pacemaker implantation. After valve excision, decalcification was deliberately incompletely performed at the commissure of the left-and non-coronary cusp to obtain a regular and circular annular margin. After implantation of the stented valve, no paravalvular leakage was noted on water irrigation testing. Upon weaning from cardiopulmonary bypass, a moderate degree of paravalvular leakage was observed by transesophageal echocardiography at the junction of the left-and non-coronary cusp. Instead of removing the valve and performing more complete decalcification to implant a larger valve, secondary balloon dilatation and warm sterile water irrigation were performed to allow further expansion and fixing of the metal alloy stent around the aortic wall to minimize the duration of aortic cross-clamp. No paravalvular leakage was observed thereafter and the patient was discharged without any complications. Preoperative computed tomography revealed right-sided pleural ￭Case Report￭

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“…The groups of Santarpino et al and König et al were the first to analyze the differences between sizes of the Perceval sutureless and the conventional stented valves. (1,12) However, in most cases, the measures provided by the manufacturers refer to the internal or the external diameter of the stent, without specifing the functional valve area. There is no corrispondence among the sizes of different sutured valves.…”

Section: Discussionmentioning

confidence: 99%

“…Advantages consist of both shortening the cardiopulmonary bypass (CPB) time and enhancing the minimally invasive approach. (1,2) From 2007, this device underwent successfully to three europeans trials (the Perceval Pilot trial, the Perceval Pivotal trial and the CAVALIER trial) obtaining the CE mark in 2011. Nowadays, it has been implanted in more than 15.000 patients.…”

Section: Introductionmentioning

confidence: 99%

Sutureless aortic valve replacement: a theoretical analysis of the effective orifice area in comparison with stented valves

Belluschi¹,

Moriggia²,

Nascimbene³

2016

ejcm

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Objective: Sutureless aortic valve replacement has recently been introduced as an alternative to conventional surgery to minimize the operative risk in elderly patients, shortening the cardiopulmonary bypass time and enhancing the minimally invasive approach. The aim of our study is to demonstrate that the sutureless bioprosthesis, compared to a conventional sutured prosthesis, has a corresponding larger effective orifice area, resulting in a better hemodynamic performance of the left ventricle. Materials and methods:In this prospective observational study, between January 2014 and September 2015, among our population of 37 sutureless aortic valve replacements, we examined 17 patients (sutureless, A group), in which a second measurement with a standard stented valve sizer has been performed during surgery. As a control group, we analyzed 10 additional aortic valve replacements who received conventional stented bioprosthesis (sutured, B group), in which an additional measurement with the sutureless sizer has been used to compare size and effective orifice areas differences between the sutureless and the sutured valves for any given annulus. Results:The size of the implanted bioprosthesis was 23,1 ± 1,9 mm and 23 ± 1,6 mm for the sutureless and sutured groups, respectively. In both groups, there were significative differences between the effective orifice areas of the implanted and the control sized prosthesis, always in favour of the sutureless valve (sutureless, A group: 2,6 ± 0,3 vs 1,4 ± 0,0 cm2, p < 0,001; sutured, B group: 1,5 ± 0,2 vs 2,9 ± 0,3 cm2, p < 0,001). Conclusions:Previous studies compared nominal sizes regardless of the effective orifice areas. For the first time, we analyzed the areas of the sutureless versus sutured bioprosthesis. For every single patient considered, the effective orifice area was significantly larger with the sutureless rather than with the sutured bioprosthesis that could fit. In sutureless aortic valve replacements, the benefits go far beyond the cardiopulmonary bypass and cross-clamp time reduction, providing larger areas and less risk of patient-prosthesis mismatch.

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The Perceval S Aortic Valve Has the Potential of Shortening Surgical Time: Does It Also Result in Improved Outcome?

Cited by 115 publications

References 15 publications

Left ventricular mass regression after sutureless implantation of the Perceval S aortic valve bioprosthesis: Preliminary results

Left ventricular mass regression after sutureless implantation of the Perceval S aortic valve bioprosthesis: Preliminary results

Intraoperative paravalvular leakage after sutureless aortic valve replacement corrected with secondary balloon dilatation -A case report-

Sutureless aortic valve replacement: a theoretical analysis of the effective orifice area in comparison with stented valves

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