International Society For Minimally Invasive Cardiothoracic Surgery

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Aortic Valve Replacement Using The Sorin Perceval Bioprosthetic Valve: Clinical Outcomes At Two Canadian Centres
Ali Fatehi Hassanabad1, Corey Adams2, Vishnu Vasanthan1, William Kent1.
1University of Calgary, Calgary, AB, Canada, 2Memorial University, St John's, NL, Canada.

Objective Recent advances in sutureless bioprosthetic valves have facilitated minimally invasive aortic valve replacement (mis-AVR) through the right anterior mini thoracotomy approach (RAMT). We aim to report on the outcomes of this technique and to discuss surgical details and echocardiographic assessment tools that can be used to ensure accurate valve deployment with this approach.
Methods This retrospective study reviewed the clinical outcomes of patients undergoing aortic valve replacement (AVR) with the Perceval bioprosthetic valve via RAMT at two Canadian centres: Memorial University and the University of Calgary. Primary outcome was death secondary to cardiac cause within 30 days of surgery and any major disabling post-surgical stroke. Secondary outcomes included surgical times, the need for permanent pacemaker (PPM), length of intensive care unit (ICU) stay, atrial fibrillation, rate of post-operative blood transfusion, and residual paravalvular leak. Echocardiographic parameters indicating correct deployment were assessed.
Results Sixty two patients underwent RAMT AVR using the Perceval valve. One patient died from cardiac cause within 30 days of surgery, whereas three patients had a neurological event. Cardiopulmonary bypass and cross clamp was 83.5 min and 53.3 min, respectively. Five patients required a PPM, and seven patients needed blood transfusion in the ICU. Length of ICU stay was 2 days. Eleven patients experienced post-operative atrial fibrillation. There was no residual paravalvular leak.
Conclusion Deployment of sutureless bioprosthetic aortic valve can be safely performed via a RAMT approach in the appropriate patient population. Our experience shows favourable clinical outcomes and suggests there may be some advantages to this approach. There are pre-operative investigations and intra-operative details, including echocardiographic criteria, which can be used to facilitate correct deployment.

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