Sutureless aortic bioprosthesis safe, feasible in patients requiring surgical AVR

A sutureless aortic bioprosthesis was associated with good outcomes in patients undergoing surgical aortic valve replacement, according to findings presented at the International Society for Minimally Invasive Cardiothoracic Surgery Annual Scientific Meeting.

The researchers analyzed 517 patients (mean age, 76 years; 64% women; mean logistic EuroSCORE, 12.2%) who underwent surgical AVR with the sutureless device (Perceval, LivaNova PLC) at a single center between March 2011 and January 2015.

“We concluded that AVR with the Perceval bioprosthesis is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance,” Marco Solinas, MD, from Ospedale del Cuore “Pasquinucci” – Fondazione G. Monasterio CNR, Massa, Italy, told Cardiology Today. “It also makes the minimally invasive procedures, especially right anterior thoracotomy, a routine operation. Today in our center, Perceval represents the biological valve of choice for minimally invasive [AVR].”

Several patients also underwent concomitant procedures: mitral valve surgery (n = 74), CABG (n = 41), tricuspid valve repair (n = 21), myectomy (n = 3) and ascending aorta replacement (n = 2).

Surgical methods included right anterior minithoracotomy (n = 330), sternotomy (n = 132) and upper ministernotomy (n = 55).

Mean cardiopulmonary bypass time was 81.2 minutes in isolated AVR procedures and 138.2 minutes in combined procedures, whereas mean aortic cross-clamp time was 50.8 minutes in isolated AVR procedures and 91.1 minutes in combined procedures, Solinas said during a presentation.

In-hospital mortality was 1.5%, whereas at mean follow-up of 19.3 months (range, 0-52.7), the survival rate was 91%, the rate of freedom from reoperation was 99% and the mean transvalvular pressure gradient was 11.4 mm Hg, Solinas said.

Among the four patients requiring reoperation, two had endocarditis, one had a degeneration of the sutureless device and required transcatheter AVR and one had an aortic root pseudoaneurysm, he said.

“Sutureless technology has been introduced as an alternative to stented valves to facilitate safe and effective implantation. By avoiding the placement of sutures, the Perceval sutureless valve simplifies [AVR] in all approaches, especially minimally invasive,” Solinas told Cardiology Today. “In our hands, Perceval significantly reduced aortic cross-clamp time and cardiopulmonary bypass time by over 40%, therefore reducing mortality and morbidity. Thanks to shorter operation and the adoption of minimally invasive technique, patients can recover faster being able to be back to their normal life earlier. The beauty of this new technology are the excellent hemodynamic results. The unique design of the superelastic stent allows to restore the physiological movement of the aortic root.

“In terms of drawbacks, the cost of the prosthesis is higher than conventional; however, the economic impact for the hospital is offset from savings due to shorter operating-room occupancy, ICU stay and in-hospital stay; and a faster recovery,” he said. – by Erik Swain

Reference:

Concistrè G, et al. State of the Art: Minimally Invasive Aortic Valve Surgery: C1. Presented at: Minimally Invasive Cardiothoracic Surgery Annual Scientific Meeting; June 15-18, 2016; Montréal.

Disclosure: Solinas reports no relevant financial disclosures.