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19.09.2017 | Original Article | Ausgabe 2/2018

Indian Journal of Thoracic and Cardiovascular Surgery 2/2018

Sutureless Perceval aortic valve implantation compared with conventional Mitroflow valve replacement

Zeitschrift:
Indian Journal of Thoracic and Cardiovascular Surgery > Ausgabe 2/2018
Autoren:
Aaron Richard Casha, Alexander Manché, Liberato Camilleri, Kentaro Yamagata, Stephanie Santucci, Marilyn Gauci, Joseph Galea

Abstract

Background

Patients at a high operative risk for conventional aortic valve replacement (AVR) may be offered sutureless valve implantation. Sutureless valves resemble conventional valves but incorporate an anchoring mechanism and features to circumvent paravalvular leaks without requiring annular sutures. Haematological and echocardiographic parameters in sutureless Perceval and conventional Mitroflow valves were compared retrospectively using risk-matched controls.

Methods

Perceval and Mitroflow valve patients were matched for pre-operative risk status using logistic Euroscore risk stratification. Haematological and echocardiographic data was collected retrospectively. Independent t tests and Mann-Whitney tests were used to compare variables between groups, with a binomial logistic regression model to determine independent variables.

Results

The use of sutureless Perceval aortic valves results in lower red cell distribution width (RDW) p = 0.001 and lower white cell (WBC) counts p = 0.034 but also resulted in a post-operative drop in platelet counts in two thirds of patients p = 0.038. A platelet level below 80 × 109/L on post-operative day 2 lengthened hospital stay in Perceval patients by 4.7 days, p = 0.050. Perceval implantation lead to lower crossclamp times p = 0.001 and bypass times p = 0.001 and reduced patient-prosthesis mismatch (p = 0.055).

Conclusions

Perceval stentless valves offer a promising alternative to conventional aortic valve replacement, with lower bypass and cross-clamp times, and an increase in indexed effective orifice area. The lower improved implantation time was associated with a lower post-operative RDW and WBC levels, indicating a muted systemic inflammatory response. The lower post-operative platelet counts delayed discharge but did not otherwise affect clinical outcome.

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