Original articleAdult cardiacSutureless Implantation of the Perceval S Aortic Valve Prosthesis Through Right Anterior Minithoracotomy
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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Cited by (53)
Early Outcomes of Sutureless Aortic Valve Replacement With the Perceval S Bioprosthesis
2019, Heart Lung and CirculationCitation Excerpt :In a study conducted by Laborde et al. [26] (n = 658), mean and peak gradients declined substantially from 44.8 and 73.24 mmHg prior to surgery, to 10.24 and 19.27 mmHg at discharge, respectively. In other studies, mean transaortic gradient at discharge ranged from 9.0 ± 3.4 to 14.6 ± 6.0 mmHg [39–42], 8.9 ± 3.2 to 12.8 ± 4.9 mmHg at 6 months [8,20,28,43,44], 8.9 ± 4.6 to 12.5 ± 4.5 mmHg [8,27,28,44] at 1 year, and 8.0 ± 3.4 to 11.8 ± 4.7 mmHg at 2 years [8,27,44]. Altogether, a transaortic gradient of approximately 10 mmHg is usually maintained over several years following SU-AVR, which is not only lower than those achieved with traditional AVR, but also TAVI [35,45].
Minimally Invasive Aortic Valve Replacement Via Right Anterior Mini-Thoracotomy: Propensity Matched Initial Experience
2019, Heart Lung and CirculationCitation Excerpt :The available data is, however, mainly focussed on hemi sternotomy approaches, and only a few studies have evaluated the right anterior mini-thoracotomy (RAMT) approach. The advantages of a RAMT approach include favourable results in terms of mortality and postoperative complications, such as a lower incidence of atrial fibrillation (AF), fewer blood transfusions, shorter mechanical ventilation times, and a shorter postoperative length of stay [6,10–18]. However, the RAMT approach has been shown to have longer cardiopulmonary bypass and cross clamp times, implying that surgical exposure and the implantation of the prosthetic valves is more challenging using the RAMT approach in comparison to the conventional approach [14,19].
Contemporary prevalence, in-hospital outcomes, and prognostic determinants of triple valve surgery: National database review involving 5,234 patients
2017, International Journal of SurgeryCitation Excerpt :Although uncommon, minimally invasive strategies have been used to perform TVS. Early reports used a right mini-thoracotomy for sutureless and double valve replacements [12,13]. In a separate publication, Antonio and colleagues describe the mini-thoractotomy approach in 5 patients undergoing TVS [14].
Exploring the learning curve for minimally invasive sutureless aortic valve replacement
2016, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Similar to other sutureless bioprosthetic valves, the Perceval S is a self-expanding valve (only short exposition under a balloon inflation may be needed) and has the potential to shorten the implantation time, thus facilitating minimally invasive AVR, especially in a subset of patients who may benefit from reduction of crossclamping and extracorporeal circulation times.4-6 Since the beginning of our experience, we have found the Perceval S valve particularly effective for the RAMT procedure.8 A limited working room issue is easily handled with this sutureless prosthesis.