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International Society For Minimally Invasive Cardiothoracic Surgery

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Impact Of Valve Sizing And Implantation Technique On Perceval Sutureless Valve Outcomes A Single Institution Experience
Qasim Al abri, Alex lu, Farshad Amirkhosravi, Moritz Wyler Von Ballmoos ,, Michael Reardon, Mahesh Ramchandani.
Houston Methodist Hospital, Houston, TX, USA.

BACKGROUND: The Perceval sutureless aortic bioprosthesis (CORCYM, United Kingdom)) was approved for use in the United States in 2016. We present the progression of our single institution experience with the sutureless Perceval valve aortic bioprosthesis over five years. With greater experience, we have become more conservative in valve sizing and implant depth has become shallower. We hypothesized that this might lead to improved outcomes.
METHODS: This is a single institution retrospective study of 206 patients undergoing AVR with the Perceval bioprosthesis from March 2016 to September 2020. Data were obtained from the institutional STS database and chart review. Patients were divided into quartiles by date of operation, to examine if outcomes improved with greater experience in implanting this valve. Among other outcomes, we looked at valve hemodynamics, paravalvular leak, and post-operative pacemaker implantation rate. RESULTS:Patient demographics were 58% male and 42% female, with mean age of 67.88.9 years. Operative approaches were conventional sternotomy (56.8%) and right mini thoracotomy (41.3%). 12.6% of patients had a history of prior cardiac surgery. Paravalvular leak was 6.8% (trace), 5.3% (mild) and 0.5% (moderate). Total postoperative rhythm disturbance requiring permanent device was 8.7% (new pacemaker), 0.97% (implantable cardioverter-defibrillator), and 0.5% (ICD and new pacemaker). Over five years, the use of XL valve decreased from 27% (Q1) to 15% (Q4), while use of S valve increased from 12% (Q1) to 29% (Q4). Correspondingly, the mean gradient at discharge decreased from 14.2 mmHg (Q1) to 12.1 mmHg (Q4). With shallower implantation and conservative sizing, the pacemaker implantation rate dropped from 12% (Q1) to 5.5% (Q4), while the rate of mild paravalvular leak remained consistent from Q1 to Q4.
CONCLUSIONS:Over time, we have become more conservative in our valve sizing. When the patient annulus is between two sizes, we choose the smaller size. Preoperative cardiac CT for size estimation augments intraoperative sizing. Also, valve implant depth has become shallower. These changes have resulted in decreased aortic gradient and pacemaker rate, while the incidence of paravalvular leak remained low. Conservative sizing and shallow depth of implantation are important for good hemodynamics and outcomes.

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