Sutureless aortic valve implantation forpuresevere native aortic valveregurgitation
Anthony Nguyen, Laurence Carmant, Ismail Bouhout, Denis Bouchard, Michel Carrier, Philippe Demers.
Montreal Heart Institute, Montreal, QC, Canada.
OBJECTIVE: This study focused on data collection and evaluation of sutureless Perceval implantation for pure native aortic valve regurgitation (NAVR).Data and experience with sutureless valves in the treatment of patients with pure severe NAVR are limited and usually considered as a contra-indication.
METHODS: From July 2011 to November 2015, we retrospectively collected data on patient characteristics, peroperative and echocardiographic parameters, and outcomes in patients undergoing sutureless valve replacement for NAVR.
RESULTS: During this timeframe, 341 patients received a Perceval valve for AVR or combined procedures at the Montreal Heart Institute. Among those, we identified 7 patients who received the Perceval for NAVR (mean age, 74.8 ± 6.5 years; 85% male; mean EuroSCORE II, 6.8 ± 5.3%). All patients had >2+ NAVR on echocardiography without aortic stenosis. Surgical access was right minithoracotomy (n=3), partial sternotomy (n=1) and full sternotomy (n=3). Implantation of the Perceval could be successfully performed in all patients, and 1 patient (14.3%) required a valve redeployment for residual aortic regurgitation peroperatively. Mean crossclamp time was 63.7 ± 28.1 and mean CBP time was 79.3 ± 36.3 min. Mean implanted prosthesis size was 26.1 ± 1.1 (median 27) mm. Concomitant procedures included 2 plications of the native annulus (28,6%), 2 CABG (28,6%), 3 mitral valve repairs (42,8%), one septal myectomy (14,3%) and one tricuspid valvuloplasty (14,3%). No paravalvular leak occurred at discharge echography. The mean transprothetic gradient was 15 ± 2.6 mmHg and the mean effective orifice area was 1,68 ± 0,39 cm2 at discharge. Permanent pacemaker implantation (PPI) was required in 3 patients (42,8%) for complete atrioventricular block. At 30 days, no major stroke or mortality occurred.
CONCLUSIONS: This study demonstrates the feasibility and potential procedure difficulties when using sutureless valve for severe NAVR. Acceptable results may be achieved in carefully selected high-risk patients, but the possibility of valve redeployment and need for PPI remain major concern.
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