Early Experience With Perceval S Sutureless Bioprostheses in patients undergoing Minimally Invasive Aortic Valve Replacement Via Right Anterior Minithoracotomy
Antonio Miceli, Michele Murzi, Danyiar Gilmanov, Matteo Ferrarini, Raffaele FugÓ, Alfredo G. Cerillo, Stefano Bevilacqua, Simone Simeoni, Pier A. Farneti, Marco Solinas, Mattia Glauber.
Fondazione Toscana G. Monasterio, Massa, Italy.
OBJECTIVE: To evaluate the postoperative outcomes of Perceval S sutureless bioprostesis in patients undergoing minimally invasive aortic valve replacement (MIAVR) through right anterior minitoracotomy (RT)
METHODS: From March 2011 to September 2012, 94 consecutive patients (mean age 77.2±6.5 years) underwent MIAVR through RT with Perceval S sutureless bioprostheses. RT was performed through a skin incision of 5-7 cm placed on the 2nd intercostal space. Direct aortic and percutaneous femoral cannulation were routinely used.
RESULTS: In-hospital mortality was 0% with a median predicted EuroSCORE of 9% (range 5%-30%). The mean aortic cross-clamp and cardiopulmonary bypass times were 42.7±13 and 72.5 ± 23 minutes, respectively. Median intensive care unit stay was 1 day (range 1-2 days) and patients were discharged after 6 (range 4-14) days. Stroke occurred in 1 patient. Incidence of permanent pacemaker was 0%. Hemodynamic at discharge showed good function of all Perceval S valves with low transvalvular pressure gradients (mean, 10 ± 4 mm Hg and peak, 21 ± 8 mm Hg). No migration or dislodgement of the valve occurred, but two mild paravalvular leakages were recorded. At median follow-up of 8 months, survival and freedom for reoperation were 100%, respectively.
CONCLUSIONS: In patients undergoing MIAVR through RT, the implantation of Perceval S sutureless bioprosthesis is simple and associated with excellent early clinical and hemodynamic outcomes. RT might be an alternative to TAVI procedures for high risk patients.
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