Elsevier

The Annals of Thoracic Surgery

Volume 96, Issue 6, December 2013, Pages 2101-2108
The Annals of Thoracic Surgery

Original article
Adult cardiac
Sutureless Implantation of the Perceval S Aortic Valve Prosthesis Through Right Anterior Minithoracotomy

Presented at the Forty-ninth Annual Meeting of The Society of Thoracic Surgeons, Los Angeles, CA, Jan 26–30, 2013.
https://doi.org/10.1016/j.athoracsur.2013.07.007Get rights and content

Background

Many new, less invasive strategies are proposed for aortic valve operation in elderly patients. Rapid deployment sutureless aortic valve prosthesis has been recently introduced. We analyzed our experience with a sutureless valve implanted through a minimally invasive approach.

Methods

A retrospective observational study with prospectively registered data was conducted on 137 patients undergoing aortic valve replacement through a right anterior minithoracotomy. Between April 2011 and January 2013, 137 consecutive patients underwent aortic valve replacement with a recently introduced, rapid deployment, sutureless pericardial valve in minithoracotomy access (47 men; mean age, 76.6 ± 7.1 years). There were 35 obese patients with a body mass index of more than 30 kg/m2. Mean logistic EuroSCORE I was 10.0; 74 (54%) patients were in New York Heart Association functional class III and IV. In all, 19 (13.9%), 45 (32.8%), and 73 (53.3%) patients received 21-, 23-, and 25-mm valve prostheses, respectively.

Results

The mean aortic cross-clamp and cardiopulmonary bypass times were 59.3 ± 19 min and 92.3 ± 27 min, respectively. No operative mortality occurred. Median stay in the intensive care unit was 1 day, with assisted ventilation necessary for a median of 6 hours. Three cases of postoperative ischemic stroke were observed (1 patient with a previous history of an ischemic cerebral event). Median hospital length of stay was 6 days.

Conclusions

A sutureless valve for minimally invasive aortic valve replacement is a feasible, effective, and safe tool. Ultimately amplifying indications for less invasive aortic valve replacement in a high surgical risk subset of patients, it can become a valid alternative for transcatheter aortic valve implantation.

Section snippets

Material and Methods

The study was approved by the clinical audit committee of the G. Pasquinucci Heart Hospital Institutional Board to meet ethical and legal requirements, and individual patient consent was waived.

Perceval S (Sorin Biomedica Cardio Srl, Saluggia, Italy) is a sutureless device designed for aortic valve replacement (AVR), comprising a functional component of two superimposed layers of pericardium and mounted in a superelastic alloy metallic cage. The cage is collapsed before implantation and is then

Results

During the study period—between April 2011 and January 2013—186 patients were treated with the Perceval S sutureless aortic valve prosthesis implant. Of these, 137 were operated on through RAMT and the remaining 49 patients through median sternotomy or partial upper sternotomy. Baseline characteristics of the study population are shown in Table 1 and Table 2.

Valve lesion distribution was as follows: 83 (60.6%) patients presented with pure stenosis, 53 (38.7%) with combined lesion, and 1 (0.7%)

Comment

Since 2008, several reports have been published on the Perceval S valvular prosthesis implant 4, 5, 16, 17, 18, 19. In March 2011 we initiated our own series of Perceval S AVR at the G. Pasquinucci Heart Hospital. Perceval S implantation through a minimally invasive approach started in April 2011. Perceval S sutureless bioprosthesis is currently available in three sizes: small, medium, and large (covering annulus diameters ranging from 19 to 21 mm, 21 to 23 mm, and 23 to 25 mm, respectively).

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