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Giovanni Concistrč, Francesca Chiaramonti, Giacomo Bianchi, Michele Murzi, Egidio Varone, Tommaso Gasbarri, Filippo Santarelli, Enkel Kallushi, Alfredo Cerillo, Pierandrea Farneti, Marco Solinas.
Ospedale del cuore "G. Pasquinucci" - Fondazione G. Monasterio CNR, Massa, Italy.

OBJECTIVE: Perceval sutureless aortic bioprosthesis (Sorin Group, Saluggia, Italy) represents an innovative approach for surgical aortic valve replacement (AVR), in order to reduce operative time and facilitate prosthesis implantation, specially in complex procedures. We described our experience with Perceval bioprosthesis in cardiac reoperations (REDO).
METHODS: From March 2011 to January 2015, 517 patients underwent AVR with sutureless aortic Perceval bioprosthesis at our Institution. Of these, 58 patients had previously undergone cardiac surgery. Mean age was 71 ± 8.7 years, 27 patients were female (46.5%), and mean logistic EuroSCORE was 26.3 ± 16.9%. Preoperative, periprocedural and echocardiographic parameters, as well as clinical outcomes, were analyzed.
RESULTS: The primary procedure was aortic valve surgery (isolated or associated with concomitant procedures) in 41 patients (71%). Isolated REDO AVR was performed in 35 patients (60%). REDO surgery was performed via full sternotomy in 51 patients (88%) and via right minithoracotomy in 7 patients (12%). Cardiopulmonary bypass and aortic cross-clamp times were 97 ± 42.1 and 53.5 ± 28.4 minutes for isolated AVR and 155.8 ± 82.7 and 95.4 ± 43 minutes for combined procedures. In-hospital deaths occurred in 3 patients (5%), one patient had cardiac death, and all patients were alive at a mean follow-up of 19.3 months (range: 0-52.7 months). Events at follow-up included cerebral hemorrhage in one patient, and the need of pacemaker implantation in 3 patients. On echocardiographic evaluation, no patient showed paraprosthetic leakages and mean transprosthesis gradient was 10±5.2 mmHg.
CONCLUSIONS: Perceval sutureless AVR is a fast and safe procedure, even in high-risk REDO surgery, providing a good hemodynamic performance with excellent clinical results.

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