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International Society For Minimally Invasive Cardiothoracic Surgery

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Early And Late Postoperative Outcomes of Right Mini Thoracotomy Sutureless Versus Sutured Aortic Valve Replacement For Severe Aortic Stenosis
Suchart Chaiyaroj, Varissara Javakijkarnjanakul, Chawannuch Ruaengsri, Omchai Rattananont, Mann Chantavimon, Pavit Pienvichit, Oraporn See, Tawai Ngernsritrakul, Somchai Viengteerawat, Panuwat Lertsitthichai
Mahidol University, Bangkok, Thailand

BACKGROUND: To evaluate the right mini thoracotomy (RMT) approach for aortic valve replacement (AVR), safety and performance of the Perceval S valve (LivaNova, Sluggia, Italy) versus sutured (SU) prosthesis in severe aortic stenosis (AS) patient.
METHODS: From November 2012 to June 2019, 57 severe AS patients underwent RMT AVR. Baseline datas, echocardiographic performance, early and long term outcomes were prospectively recorded and analyzed.
RESULTS: There were 30 sutured (SU) prosthesis (19 mechanical valve, 11 pericardial bioprosthesis) and 27 sutureless (SL) AVR. SU (group I) and SL (group II) were compared. Mean age was 62.1012.3 year (I), 75.077.12 year (II). Mean Euro II and STS score were 2.650.85 and 3.221.13 (I), 3.361.25 and 4.42.56 (II). Mean valve size was 20.331.69 mm (I), 24.191.59 mm (II). Mean cross clamp time was 80.7726.43 minutes (I), 65.7023.63 minutes (II). There was no operative mortality. Paravalvular leakage (PVL) and pacemaker implantation rate were 0, 3.33% (I) and 3.7%, 0% (II). Patients with 19 to 21 mm bio prostheses, mean pressure gradient and effective orifice area index at six months postoperatively were 17.40.6 mm Hg and 0.710.59 cm2 (SU), 13.10.5 mm Hg and 0.950.14 cm2 (SL). Survival at one and five year were 99% and 93% (I), 97% and 85% (II). Comparative studies of RMT SL AVR (27) versus sutured prosthesis (30) showed non inferiority results.
CONCLUSIONS: Our experience with RMT Perceval SL AVR in severe AS has shown safety, 3.7% PVL, no pacemaker, less CCT, larger valve size implantation, better hemodynamic performance in small size annulus, satisfactory early and five year outcomes comparing to sutured prosthesis.


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