Conventional Aortic Valve Replacement Research Articles

Early structural valve deterioration following transcatheter aortic valve implantation in a patient with Scheie syndrome: a case report

BackgroundScheie syndrome, an attenuated subtype of mucopolysaccharidosis type I, is a rare storage disease that causes progressive glycosaminoglycans (GAGs) accumulation. Cardiovascular disorders determine the prognosis, and cardiac valve abnormalities are the most common cause. The patients are usually young so mechanical valve replacement is often performed, but because of the features of this disease, the surgical treatment is very risky. Recently, transcatheter aortic valve implantation (TAVI) has been reported as an alternative choice for aortic stenosis, but optimal choice is still unclear. Here, we introduce a patient that underwent TAVI and refer to the histological finding of a biological valve extracted in relation to GAGs accumulation.Case presentationA 54-year-old woman with Scheie syndrome underwent valve surgeries three times throughout her whole life. At age 41, she received a mitral valve replacement with a mechanical valve for mitral stenosis. She promptly developed severe diastolic dysfunction and low output syndrome after the release of aortic clamping, thus requiring temporary mechanical circulatory support4. At age 51, she suffered from heart failure due to severe aortic stenosis and underwent TAVI because conventional aortic valve replacement (AVR) was deemed too risky. Three years later, her heart failure relapsed, and an echocardiogram unexpectedly revealed thickened bioprosthetic valve leaflets and a significant pressure gradient across the valve, consistent with early structural valve deterioration. AVR was performed via median sternotomy with a mechanical valve. As with the first operation, she presented refractory heart failure requiring mechanical circulatory support and was meticulously managed. However, she steadily showed worsening of multiple organ systems and died 9 days after the operation. Pathological autopsy and histological examination revealed accumulation of tissue with GAGs on the leaflets of the bioprosthetic valve of TAVI, which may have been the cause of early structural valve deterioration.ConclusionFor patients with Scheie syndrome, a biological valve can be compromised by the accumulation of GAGs, thereby causing early SVD. These findings may support valve selection for these high-risk patients.

Anaesthetic and Procedural-Related Complications in Transcatheter Aortic Valve Implantation (TAVI) and Its Outcome: A Retrospective Observational Study.

Background Transcatheter aortic valve implantation (TAVI) presents significant challenges in its management, not only due to the technical complexity of the procedure but also because it is primarily performed on elderly patients who often have multiple comorbidities, making perioperative care and post-procedural recovery more intricate and demanding. The study's objective is to discover the challenges faced during the TAVI procedure and the frequency of complications that occurred during and after the procedure. Methods This is a single-centre retrospective study. Patients with symptomatic severe aortic stenosis, considered at high risk for conventional surgical aortic valve replacement, were included, their medical records were extracted, and data were collected. Endpoints at one-year follow-up comprised one-year mortality, cause of death, and valve dysfunction. Procedural-related complications were also noted as procedural-related outcomes. Results The mean age and body mass index (BMI) of the patients were 73.9 years and 28.3 kg/m2, respectively. The main comorbidities were hypertension (n = 33, 84.6%), diabetes mellites (n = 21, 53.8%), ischemic heart disease (n = 6, 15.38%), and chronic obstructive pulmonary disease (COPD) (n = 5, 12.8%). The mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 5.75% with a median of 2.38%. General anaesthesia was received (n = 27), whereas the rest of the cases were performed under monitored anaesthesia care (MAC). None of the patients developed surgical site hematoma or massive blood loss. Post-operative mechanical ventilation was required in three patients (10.2%), and two (5.12%) of them expired in the intensive care unit. One patient had on-table mortality. Conclusion A low rate of anaesthesia and procedural-related complications was observed. The TAVI procedures done in our centre are promising and parallel to the finest global centres' outcomes in terms of procedural triumph and complication rate.

Aortic valve replacement in younger patients with aortic valve insuffienciency

Aortic valve replacement is the common treatment of choice for severe aortic valve insufficiency (AI). AI is often caused by aortic root dilatation which leads to valve incompetence despite structurally normal valve leaflets. For this condition, aortic repair surgery with ring annuloplasty is considered a potentially superior option. Despite the availability of different annuloplasty rings, no guidelines for the surgical procedure nor the choice of annuloplasty ring exist. In this review, we outline the surgical treatment using valve-preserving procedures as an alternative to conventional aortic valve replacement.

Bleeding in minimally invasive versus conventional aortic valve replacement

BackgroundObservational studies have shown reduced perioperative bleeding in patients undergoing minimally invasive, compared with full sternotomy, aortic valve replacement. Data from randomized trials are conflicting.MethodsThis was a Swedish single center study where adult patients with aortic stenosis, 100 patients were randomly assigned in a 1:1 ratio to undergo either minimally invasive (ministernotomy) or full sternotomy aortic valve replacement. The primary outcome was severe or massive bleeding defined by the Universal Definition of Perioperative Bleeding in adult cardiac surgery (UDPB). Secondary outcomes included blood product transfusions, chest tube output, re-exploration for bleeding, and several other clinically relevant events.ResultsOut of 100 patients, three patients randomized to ministernotomy were intraoperatively converted to full sternotomy (none was bleeding-related). Three patients (6%) in the full sternotomy group and 3 patients (6%) in the ministernotomy group suffered severe or massive postoperative bleeding according to the UDPB definition (p = 1.00). Mean chest tube output during the first 12 postoperative hours was 350 (standard deviation (SD) 220) ml in the full sternotomy group and 270 (SD 190) ml in the ministernotomy group (p = 0.08). 28% of patients in the full sternotomy group and 36% of patients in the ministernotomy group received at least one packed red blood cells transfusion (p = 0.39). Two patients in each group (4%) underwent re-exploration for bleeding.ConclusionsMinimally invasive aortic valve replacement did not result in less bleeding-related outcomes compared to full sternotomy.Clinical Trial Registrationhttp://www.clinicaltrials.gov. Unique identifier: NCT02272621.

DEDICATE trial: the devil lies in the definition of "low risk".

Transcatheter aortic-valve replacement (TAVR) has evolved from a treatment strategy for high-risk patients to an option for low-risk individuals, prompting the need for rigorous comparisons with surgical aortic-valve replacement (SAVR). The German-Austrian Prospective Randomized Trial of Transcatheter Aortic Valve Implantation Versus Conventional Surgical Aortic Valve Replacement in Low and Intermediate Risk Patients (DEDICATE) trial compares low- and intermediate-risk patient undergoing SAVR and TAVR. This review outlines the trial design, key findings, strengths, and weaknesses of the study and also highlights the urgent need for standardized definitions of low-risk patients in future trials to ensure accurate comparisons and robust conclusions.

Postoperative quality of life and pain after upper hemisternotomy and conventional median sternotomy for aortic valve replacement: results of a randomized clinical trial.

Surgical aortic valve replacement through conventional sternotomy yields excellent results. Minimally invasive techniques are deemed equally safe and serve as a viable and less traumatic alternative. However, it is unclear how both surgical techniques affect patient-reported outcomes. The objective of this trial is to compare postoperative cardiac-related quality of life and postoperative pain after upper hemisternotomy and conventional surgical aortic valve replacement. In this single-centre, open-label, investigator-initiated randomized clinical trial, patients were randomized to upper hemisternotomy or conventional full median sternotomy. Patients unable to undergo randomization were monitored prospectively (registry group). Primary outcome was cardiac-specific quality of life, measured with the Kansas City Cardiomyopathy Questionnaire up to 1 year postoperatively. Patients undergoing upper hemisternotomy had a significantly higher physical limitation domain score across all postoperative time points than patients undergoing conventional surgical aortic valve replacement (estimated mean difference 2.12 points; P = 0.014). Patients undergoing upper hemisternotomy were more likely to have a pain score <30 the first 2 days postoperatively than patients undergoing conventional surgical aortic valve replacement (odds ratio 2.63; P = 0.007). This was associated with reduced opioid analgesic intake. Postoperative surgical outcome did not differ between both groups. Surgical aortic valve replacement through both conventional sternotomy and upper hemisternotomy resulted in clinically similar and important improvements in quality of life, with a small advantage for upper hemisternotomy, while there was no compromise in safety.

Surgical explantation for a rapid deployment valve: the 'shave-and-hook technique'.

An 80-year-old female patient underwent redo aortic valve replacement for haemolysis caused by moderate paravalvular leakage 1 year after a 21-mm Intuity Elite valve implantation. The elevatorium passed at the segment with paravalvular leakage. The frame was then bent inward using a hook and the peel around the sawing ring was shaved by an elevatorium. After explantation of the Intuity Elite valve, endoscopic examination showed no sign of annular or sub-annular damage. Conventional aortic valve replacement using a biological valve was performed. We introduce a safe alternative technique for explantation of a rapid deployed valve.

Thrombocytopenia after sutureless and standard stented aortic valve replacement: a retrospective analysis of risk factors, clinical course, and early outcome

ObjectivesThrombocytopenia following Perceval aortic valve replacement has been described previously with variable outcome. Studies have lacked a robust analysis of platelet fluctuation and factors affecting it. We aimed to statistically describe the trend in thrombocyte variability as compared with conventional aortic valve replacement, and to assess predictors as well as impact on associated outcomes.MethodsOne hundred consecutive patients with first-time Perceval were retrospectively compared to 219 patients after Perimount Magna Ease valve replacement. The primary outcome was the serial thrombocyte count on day 0–6. Generalized estimating equations were used to analyse the data using fixed-effect models: for the effect of the post-operative day on platelet count, and random-effect models estimating both time-variant (platelets) and time in-variant variables (valve type, age, LV function, pre-op platelet level).ResultsPerceval patients were older (72 ± 1 vs 68 ± 1 years, p < 0.01) with higher NYHA status (3(2–3) vs 2(1–2), p < 0.001). Mean platelet count in the sutureless group was lowest on day 2 (91.9 ± 31.6 vs 121.7 ± 53.8 × 103 µl−1), and lower on day 4 (97.9 ± 44) and 6 (110.6 ± 61) compared to the conventional group (157.2 ± 60 and 181.7 ± 79) but did not result in a higher number of transfusions, bleeding or longer hospital stay (p > 0.05). Reduced platelet count was a strong predictor of red cell transfusion in the conventional (p = 0.016), but not in the sutureless group (p = 0.457). Age (Coef -1.025, 95%CI-1.649—-0.401, p < 0.001) and CPB-time (Coef 0.186, 95%CI-0.371—-0.001, p = 0.048) were predictors for lower platelet levels.ConclusionConsidering the older patient profile treated with Perceval, postoperative thrombocytopenia does not impact on outcome in terms of transfusions, complications or hospital stay.

Minimally Invasive and Full Sternotomy Aortic Valve Replacements Lead to Comparable Long-Term Outcomes in Elderly Higher-Risk Patients: A Propensity-Matched Comparison.

Minimally invasive aortic valve replacement (AVR) via upper ministernotomy (MiniAVR) is a standard alternative to full sternotomy access. Minimally invasive cardiac surgery has been proven to provide a number of benefits to patients. The aim of this study was to compare the short- and long-term outcomes after MiniAVR versus conventional AVR via full sternotomy (FS) using a biological prosthesis in an elderly higher-risk population. Between January 2006 and July 2009, 918 consecutive patients received AVR ± additional procedures with different prostheses at our center. Amongst them, 441 received isolated AVR using a biological prosthesis (median age of 74.5; range: 52-93 years; 50% females) and formed the study population (EuroSCORE II: 3.62 ± 5.5, range: 0.7-42). In total, 137 (31.1%) of the operations were carried out through FS, and 304 (68.9%) were carried out via MiniAVR. Follow-up was complete in 96% of the cases (median of 7.6 years, 6610 patient-years). Propensity score matching (PSM) resulted in two groups of 68 patients with very similar baseline profiles. The primary endpoints were long-term survival, freedom from reoperation, and endocarditis, and the secondary endpoints were early major adverse cardiac and cerebrovascular events (MACCEs). FS led to shorter cardio-pulmonary bypass and aortic cross-clamp durations: 90 (47-194) vs. 100 (46-246) min (p = 0.039) and 57 (33-156) vs. 69 (32-118) min (p = 0.006), respectively. Perioperative stroke occurred in three patients (4.4%; FS) vs. one patient (1.5%; MiniAVR) (p = 0.506). The 30-day mortality was similar in both groups (2.9%, p = 1.000). Survival at 1, 5, and 10 years was 94.1 ± 3% (FS and MiniAVR), 80.3 ± 5% vs. 75.7 ± 5%, and 45.3 ± 6% vs. 43.8 ± 6%, respectively (p = 0.767). There were two (2.9%) reoperations in each group and two thrombo-embolic events (2.9%) vs. one (1.5%) thrombo-embolic event in the MiniAVR and FS groups, respectively (p = 0.596). In comparison to FS, MiniAVR provided similar short- and long-term outcomes in a higher-risk elderly population receiving biological prostheses. In particular, long-term survival, freedom from reoperation, and the incidence of endocarditis were comparable. These results clearly advocate for the routine use of MiniAVR as a standard procedure for AVR, even in a high-risk population.

TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and multivessel or advanced coronary disease: The transcatheter valve and vessels trial (TCW trial): Design and rationale

Background: Patients with severe aortic stenosis (AS) frequently present with concomitant obstructive coronary artery disease (CAD). In those, current guidelines recommend combined coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) as the preferred treatment option, although this surgical approach is associated with a high rate of clinical events. Combined transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) with or without FFR have evolved as a valid alternative for cardiac surgery in patients with AS and multivessel or advanced CAD. To date, no dedicated trial has prospectively evaluated the outcomes of a percutaneous versus surgical treatment for patients with both severe AS and CAD. Aims: To investigate whether fractional-flow reserve (FFR)-guided PCI and TAVI is non-inferior to combined CABG and SAVR for the treatment of severe AS and multivessel or advanced CAD. Methods: The Transcatheter Valve and Vessels (TCW) trial (clinicaltrial.gov: NCT03424941) is a prospective, randomized, controlled, open label, international trial. Patients ≥ 70 years with severe AS and multivessel (≥ 2 vessels) or advanced CAD, deemed feasible by the heart team for both; a full percutaneous or surgical treatment, will be randomised in a 1:1 fashion to either FFR-guided PCI followed by TAVI (intervention arm) vs. CABG and SAVR (control arm). The primary endpoint is a patient-oriented composite of all-cause mortality, myocardial infarction, disabling stroke, unscheduled clinically-driven target vessel revascularization, valve re-intervention, and life threatening or disabling bleeding at one year. The TCW trial is powered for non-inferiority, and if met, superiority will be tested. Assuming a primary endpoint rate of 30% in the CABG-SAVR arm, with a significance level α of 5%, a non-inferiority limit delta of 15% and a loss to follow-up of 2%, a total of 328 patients are needed to obtain a power of 90%. The primary endpoint analysis is performed on an intention-to-treat basis. Summary: The TCW Trial is the first prospective randomized trial that will study if a less invasive percutaneous treatment for severe AS and concomitant advanced CAD (i.e., FFR-guided PCI - TAVI) is non-inferior to the guidelines recommended approach (CABG-SAVR).

Cost-utility analysis of sutureless and rapid deployment versus conventional aortic valve replacement in patients with moderate to severe aortic stenosis in Thailand.

Sutureless and rapid deployment aortic valve replacement (SUAVR) has become an alternative to conventional aortic valve replacement (CAVR) for aortic stenosis (AS) treatment due to its advantages in reducing surgery time and improving outcomes. This study aimed to assess the cost-utility of SUAVR vs. CAVR treatment for patients with moderate to severe AS in Thailand. A two-part constructed model was used to estimate the lifetime costs and quality-adjusted life years (QALYs) from both societal and healthcare perspectives. Data on short-term mortality, complications, cost, and utility data were obtained from the Thai population. Long-term clinical data were derived from clinical studies. Costs and QALYs were discounted annually at 3% and presented as 2022 values. The incremental cost-effectiveness ratio (ICER) was calculated to determine additional cost per QALY gained. Deterministic and probabilistic sensitivity analyses were performed. SUAVR treatment incurred higher costs compared with CAVR treatment from both societal (THB 1,733,355 [USD 147,897] vs THB 1,220,643 [USD 104,150]) and healthcare provider perspectives (THB 1,594,174 [USD 136,022] vs THB 1,065,460 [USD 90,910]). In addition, SUAVR treatment resulted in lower health outcomes, with 6.20 life-years (LYs) and 4.95 QALYs, while CAVR treatment achieved 6.29 LYs and 5.08 QALYs. SUAVR treatment was considered as a dominated treatment strategy using both perspectives. Sensitivity analyses indicated the significant impact of changes in utilities and long-term mortality on the model. SUAVR treatment is not a cost-effective treatment strategy compared with CAVR treatment for patients with moderate-severe AS in Thailand, as it leads to higher costs and inferior health outcomes. Other important issues related to specific patients such as those with minimally invasive surgery, those undergoing AVR with concomitant procedures, and those with calcified and small aortic root should be taken into account.

Outcomes of Minimally Invasive Aortic Valve Replacement in Obese Patients: A Propensity-Matched Study.

Obese patients are at risk of complications after cardiac surgery. The aim of this study is to investigate safety and efficacy of a minimally invasive approach via upper sternotomy in this setting. We retrospectively reviewed 203 obese patients who underwent isolated, elective aortic valve replacement between January 2014 and January 2023 - 106 with minimally invasive aortic valve replacement (MIAVR) and 97 with conventional aortic valve replacement (CAVR). To account for baseline differences, a propensity-matching analysis was performed obtaining two balanced groups of 91 patients each. The 30-day mortality rate was comparable between groups (1.1% MIAVR vs. 0% CAVR, P=0.99). MIAVR patients had faster extubation than CAVR patients (6 ± 2 vs. 9 ± 2 hours, P<0.01). Continuous positive airway pressure therapy was less common in the MIAVR than in the CAVR group (3.3% vs. 13.2%, P=0.03). Other postoperative complications did not differ significantly. Intensive care unit stay (1.8 ± 1.2 vs. 3.2 ± 1.4 days, P<0.01), but not hospital stay (6.7 ± 2.1 vs. 7.2 ± 1.9 days, P=0.09), was shorter for MIAVR than for CAVR patients. Follow-up survival was comparable (logrank P-value = 0.58). MIAVR via upper sternotomy has been shown to be a safe and effective option for obese patients. Respiratory outcome was promising with shorter mechanical ventilation time and reduced need for post-extubation support. The length of stay in the intensive care unit was reduced. These advantages might be important for the obese patient to whom minimally invasive surgery should not be denied.

Aortic valve neocuspidization using the Ozaki Technique for bicuspid aortic valve: The first case at Central Military Hospital of Azerbaijan

Conventional aortic valve replacement (AVR) remains the standard treatment for aortic valve stenosis or insufficiency, but emerging techniques focus on valve reconstruction rather than replacement. One such method is the Ozaki procedure, which involves replacing each valve leaflet with glutaraldehyde-treated autologous pericardium to restore the natural anatomy of the aortic valve. Although challenging, especially for bicuspid aortic valves, this technique has shown success after a learning period. We report the case of a 54-year-old woman with a history of colorectal cancer, who underwent surgery for severe stenosis of a bicuspid aortic valve using tricuspidization with glutaraldehyde-treated autologous pericardium.

Is there still role for the Ross procedure?

The ideal aortic valve substitute for young and middle-aged adults with aortic valve disease is still debated. The Ross procedure (pulmonary autograft replacement) is the only operation that allows replacement of the diseased aortic valve with a living substitute. During the years, the use of this procedure has declined significantly due to concerns over increased intraoperative risk and especially potential long-term failure of the operation. However, several recent publications have shown that, after appropriate learning curve and in specialized centers, the Ross procedure can be performed safely in appropriately selected patients. Moreover, comparative studies suggest that the Ross procedure is associated with better long-term outcomes compared to conventional aortic valve replacement in young and middle-aged adults.

Sutureless and rapid-deployment versus conventional bioprosthetic aortic valve replacement in patients with aortic stenosis: a systematic review and meta-analysis of randomised controlled trials

Abstract Background Sutureless aortic valve replacement (SUAVR) has become an alternative to conventional bioprosthetic aortic valve replacement (CAVR) for the treatment of aortic stenosis. This procedure was designed to shorten surgery time, enable optimal valve insertion, and improve surgical outcomes. Purpose This study aimed to compare the clinical outcomes between SUAVR and CAVR for treating patients with aortic stenosis. Methods Systematic searches were conducted from the inception to December 2022, using 4 databases: PubMed, Scopus, Embase, and Web of Sciences. Randomised controlled trials comparing SUAVR versus CAVR were included for analyses. Data were extracted and analysed using predefined clinical outcomes. The revised Cochrane risk-of-bias tool for randomized trials version 2.0 was used to assess the quality of included RCTs. A meta-analysis with risk ratio (RR) or mean difference (MD) was performed to compare clinical outcomes such as aortic cross-clamp (ACC) time, cardiopulmonary bypass (CPB) time, mortality, and complications at 30 days and 1 year. Results The study included 4 articles with a total of 478 SUAVR and 485 CAVR patients. Compared to CAVR, SUAVR had a significantly shorter ACC time (MD -25.1 minutes, 95%CI -44.5 to -5.8, I2 =97%, p 0.01) and CPB time (MD -22.8 minutes, 95% CI -42.4 to -3.2, I2 =93%, p 0.02). There was no significant difference in mortality at 30-day (RR 1.04, 95%CI 0.34-3.15, I2 =0%, p 0.952) and 1-year follow-up (RR 1.08, 95%CI 0.56-2.06, I2 =0%, p 0.822). Complications including myocardial infarction, stroke, major bleeding, renal failure, and endocarditis, did not significantly differ between the two groups. However, permanent pacemaker implantation was significantly higher after SUAVR at 30 days (RR 3.25, 95%CI 1.81-5.84, I2 =0%, p &amp;lt;0.01) and 1 year (RR 2.97, 95%CI 1.71-5.16, I2 =0%, p &amp;lt;0.01). Conclusions SUAVR had significantly shorter ACC and CPB times than CAVR. SUAVR required more permanent pacemaker implantation than CAVR. Mortality and other complications were comparable between the two groups.

Short-term outcomes of aortic valve neocuspidization using autologous fixed pericardium versus aortic valve replacement using mechanical prosthesis in patients with aortic valve disease

Background Aortic valve replacement by prosthetic valves, either mechanical or biological, is the ultimate known therapy for patients with aortic valve disease whether stenosis or regurgitation. However, these prostheses may have the concern of valve degeneration and the need for reoperation with the biological valves or the need for lifelong anticoagulation with considerable side effects with the mechanical valves. In this study, we compare the application of the new Ozaki technique in Ain Shams University Hospitals Cardiothoracic Academy to the current practice of aortic valve replacement using mechanical valve prosthesis Aim of the work To study the hemodynamic performance and major adverse events that are related to the valve of the novel technique in reconstructing the aortic valve using autologous pericardium (AVNeo) versus the conventional aortic valve replacement using a prosthetic mechanical valve. Patients and methods This was a nonrandomized clinical trial on 20 patients conducted at Ain Shams University Hospitals Cardiothoracic Academy during the period from November 2021 to December 2022. Inclusion criteria include age from 18 to 65 years, moderate to severe aortic stenosis, and sole aortic valve disease. Exclusion criteria include refusal of the Ozaki technique, concomitant intervention of the aortic arch, emergency surgery, porcelain aorta, and previous cardiac surgery. We divided the patient population into two groups through nonrandom allocation: Group I: aortic valve neocuspidization using autologous fixed pericardium and group II: aortic valve replacement using mechanical prosthesis. Results The hemodynamic performance of patients who underwent aortic valve replacement with either the AVNeo or AVR techniques was evaluated at discharge and 3 months postsurgery. No significant differences were observed in mean and median values of MPG, vena contracta, and coaptation length between the groups at discharge and 3 months postsurgery. However, at 3 months, the mean PPG was significantly lower in the AVNeo group compared with the AVR group (14.80±3.01 vs. 24.00±6.80, P&lt;0.001). In addition, there was a significant decrease in mean PPG and MPG values within the AVNeo group at 3 months compared with at discharge (P=0.005 and P&lt;0.001, respectively), whereas no significant change was observed in the AVR group. These findings suggest that the AVNeo technique may offer better hemodynamic outcomes in terms of PPG compared with the AVR technique at 3 months postsurgery. Conclusion Results showed that both AVNeo and AVR exhibit comparable outcomes at discharge and at 3 months after the study’s conclusion. The postoperative morbidity and mortality are low with the Ozaki procedure, making it dependable and safe.

Clinical and hemodynamic outcomes of the Perceval sutureless aortic valve from a real-world registry.

Perceval sutureless valve has been in clinical use for >15 years. The aim of this study is to report the real-word clinical and haemodynamic performance from the SURE-aortic valve replacement international prospective registry in patients who underwent aortic valve replacement with Perceval valve. From 2011 to 2021, patients from 55 institutions received a Perceval valve. Postoperative, follow-up, and echocardiographic outcomes were analysed. A total of 1652 patients were included; mean age was 75.3 ± 7.0 years (53.9% female); mean EuroSCORE II was 4.1 ± 6.3. Minimally invasive approach was performed in 45.3% of patients; concomitant procedures were done in 35.9% of cases. Within 30 days, 0.3 and 0.7% valve-related reinterventions were reported. Transient ischaemic attack, disabling and non-disabling strokes were limited (0.4%, 0.4% and 0.7%, respectively). Pacemaker implant was required in 5.7% of patients. Intra-prosthetic regurgitation ≥2 was present in 0.2% of cases, while paravalvular leak ≥2 in only 0.1%. At a maximum follow-up of 8 years, 1.9% of cardiovascular deaths and 0.8% of valve-related reintervention occurred. Among the 10 cases of structural valve deterioration (mean 5.6 ± 1.4 years after implant; range: 2.6-7.3 years), 9 were treated with a transcatheter vale-in-valve implantation and 1 with explant. Mean pressure gradient decreased from 45.8 ± 16.5 mmHg preoperatively to 13.3 ± 5.2 mmHg at discharge and remained stable during follow-up. This experience represents the largest prospective real-world cohort of patients treated with Perceval showing that Perceval is a safe and effective alternative to conventional surgical aortic valve replacement, providing favourable clinical and haemodynamic results also at mid-term follow-up.

Outcomes of Rapid Deployment Aortic Valve Replacement: Early Experience in Wellington Hospital

Rapid deployment (RD) aortic valve replacement (AVR) using the Edwards Intuity Elite Valve System is a significant breakthrough in advancement in comparison with other current conventional sutured surgical AVR. This study aimed to analyse early experiences using this novel bioprosthesis. This 60-month prospective study, between July 2017 and July 2022, found that 59 patients had RD bioprosthesis implanted at this institution. Median follow-up period was 12 months. Baseline preoperative characteristics, isolated or concomitant procedures, valve prosthesis-related events, survival rates, and valve haemodynamics were evaluated. Primary endpoints were pacemaker implantation (PPM) rates, neurological events, paravalvular leaks, and early 30-day mortality rates. Secondary endpoints were reintervention, valve degeneration, arrhythmia, hospital stay, and readmission rates. Approximately 64% were males, with the mean age of 75±3 years. Isolated AVR was performed in 54% and the rest were concomitant procedures. Cardiopulmonary bypass and cross-clamping times were acceptable. In the isolated AVR group, the early PPM implantation rates were 5%, with 1.7% of patients experiencing a minor stroke event. One patient had paravalvular leak, which was moderate in haemodynamics. Mean gradient at discharge was 11±3 mmHg. There was no early inpatient mortality in the isolated AVR group, and the 30-day post-discharge mortality was zero. Re-operation rates and valve degeneration rates were zero. This study found promising and excellent early results in this small cohort of patients, validating for more usage of rapid deployment AVR in suitable patients.

Perceval Sutureless Versus Conventional Sutured Bioprosthetic Aortic Valve Replacement: A Propensity Score Matched Study

This study evaluated the clinical outcomes and new permanent pacemaker (PPM) rates after surgical aortic valve replacement (AVR) with the Perceval sutureless versus conventional sutured bioprosthetic AVR.

Outcomes of Rapid Deployment Aortic Valve Replacement: Early Experience in Wellington Hospital

Rapid deployment (RD) aortic valve replacement (AVR) using the Edwards Intuity Elite Valve System is a significant breakthrough in advancement in comparison with other current conventional sutured surgical AVR. This study aimed to analyse early experiences using this novel bioprosthesis.