The Elimination Of Patient Prosthetic Mismatch Using The Perceval Sutureless Aortic Prosthesis
CHARLENE E. TENNYSON, MARK BOYLE, Abdelrahman Mohammad Abdelbar, Gunaratnam NIRANJAN,, ANTONY WALKER, AMAL BOSE.
BLACKPOOL VICTORIA HOSPITAL, BLACKPOOL, United Kingdom.
BACKGROUND - Patient-prosthetic mismatch (PPM) arises when the effective orifice area (EOA) of an implanted prosthetic valve is too small in relation to the patient’s body surface area (BSA); it is associated with adverse clinical and haemodynamic outcomes. Our aim was to compare the incidence of PPM in conventional and sutureless-aortic valve replacement (AVR) recipients.METHODS - We included all patients who underwent an AVR between July 2014 and June 2019; PPM was defined as a projected indexed iEOA≤0.85 cm2/m2. We used 1:1 exact-matching between the Sutureless-AVR group and the Conventional-AVR group on the basis of sex and BSA. Statistical testing was undertaken using χ2 test for categorical variables and Kolmogorov-Smirnov test for numeric variables. P-values were calculated for normally and not normally distributed variables and using a t-test and Wilcoxon signed rank test, respectively.RESULTS - We had 1178 AVRs (296 sutureless); after matching there were 223 pairs. The mean iEOA was 1.46± 0.11cm2/m2 and 0.94±0.07cm2/m2 in the sutureless and conventional group respectively, (p<0.0001). There were no patients with PPM in the sutureless-group. In the conventional-AVR group 43 patients developed PPM (19.3%) of which 40 were moderate PPM (17.9%) and 3 patients had severe PPM (1.3%). There was no statistically-significant difference in 30 day or 1 to 3-year mortality between the groups.CONCLUSIONS - We demonstrate use of a Perceval sutureless prosthesis to be associated with a larger indexed EOA compared to conventional valves. There were no cases of PPM following sutureless, compared to 19.3% following conventional-valve use. There was no significant difference in mortality rates up to 3 years post-implantation despite sutureless valve recipients having a significantly higher-risk profile. Our data demonstrates the Perceval sutureless prosthesis to be the logical valve of choice in high surgical risk and cases with a high risk of developing PPM.
LEGEND
| Parameter | Perceval (n=223) | Sutured (n=223) | p-value |
| Age (y.o.) | 78 [73.5-82] | 75 [69-79] | p<0.0001 |
| Logistic Euroscore | 10.7 [7.0-16.0] | 7.0 [4.6-12.6] | p<0.0001 |
| BMI (UNITS) | 28.3 (4.9) | 27.5 (4.6) | p=0.0035 |
| NYHA III-IV | 120 (53.8%) | 94 (42.1%) | p=0.0178 |
| CPB time (min) | 83 [63-119.5] | 127 [100-153] | p<0.0001 |
| XCT (min) | 51 [39-75] | 95 [74-114] | p<0.0001 |
| Postoperative hospital stay (days) | 8 [6-13] | 7 [6-10.5] | p=0.0067 |
| EOA (cm2) | 2.72 [2.47-2.95] | 1.81 [1.69-1.87] | p<0.0001 |
| iEOA (cm2/m2) | 1.46 [1.35-1.57] | 0.94 [ 0.87-1.01] | p<0.0001 |
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