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DOI: 10.1055/s-0042-1742684
Sutureless Valve in Bicuspid Aortic Stenosis: Modified Technique and Midterm Outcome
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Abstract
Background The sutureless valve has gained popularity for degenerative aortic valve stenosis but not congenital bicuspid aortic valve (BAV) due to anatomical challenges. We reviewed our modified implant techniques for patients with BAV.
Methods From June 2015 to June 2019, 66 patients with aortic valve stenosis were treated with the Perceval sutureless valve, 20 of whom had BAV. The demographics, type of BAV (the Sievers classification), and associated pathologies, surgical outcomes, and midterm hemodynamics were recorded.
Results The median age was 64 (range: 49–81) years and the Society of Thoracic Surgeons score was 2.186 (range: 0.407–6.384). Annular plication was performed in 9 (75%) of 12 type 0 and 3 (37.5%) of 8 type I, with implanted valve sizes of M, L, and XL in 6, 10, 4 cases, respectively. Three patients, all type 0 in the initial learning periods, required intraoperative redeployment due to malposition of the valve. The final implant was successful in all without conversion to traditional prosthesis. The median extubation time was 4 hours and the durations of intensive care unit and hospital stay were 1 and 6 days. At a median follow-up of 46 (23–72) months, there was one late mortality due to hemorrhagic stroke sequel. The last echo revealed none had more than mild paravalvular leakage and the mean transvalvular pressure gradient remained stable at 9.70 (range: 6.94–15.0) mm Hg.
Conclusion The sutureless valve can achieve satisfactory outcomes in BAV without paravalvular leakage and excellent hemodynamics. It may serve as the benchmark for transcatheter aortic valve implantation in this unique population.
Keywords
aortic valve stenosis - aortic valve replacement - congenital bicuspid aortic valve - Perceval sutureless valvePublication History
Received: 07 October 2021
Accepted: 13 December 2021
Article published online:
10 February 2022
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References
- 1 Shrestha M, Fischlein T, Meuris B. et al. European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patients. Eur J Cardiothorac Surg 2016; 49 (01) 234-241
- 2 Laborde F, Fischlein T, Hakim-Meibodi K. et al; Cavalier Trial Investigators. Clinical and haemodynamic outcomes in 658 patients receiving the Perceval sutureless aortic valve: early results from a prospective European multicentre study (the Cavalier Trial). Eur J Cardiothorac Surg 2016; 49 (03) 978-986
- 3 Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 2007; 133 (05) 1226-1233
- 4 Glauber M, Moten SC, Quaini E. et al. International expert consensus on Perceval sutureless and rapid deployment valves in aortic valve replacement using minimally invasive approaches. Innovations (Phila) 2016; 11 (03) 165-173
- 5 Gersak B, Fischlein T, Folliguet TA. et al. Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel. Eur J Cardiothorac Surg 2016; 49 (03) 709-718
- 6 Lin CY, Lee HA, Lin PJ, Wang CL, Hung KC, Tsai FC. Sutureless aortic bioprosthesis replacement in elderly Asian patients with aortic stenosis: Experience in a single institution. Biomed J 2018; 41 (04) 265-272
- 7 Tsai FC, Li HY, Chou AH, Huang HC, Gersak B. Modified implant technique of Perceval sutureless valve in congenital type 0 bicuspid valve stenosis. Ann Thorac Surg 2021; 111 (05) e369-e371
- 8 Tadros TM, Klein MD, Shapira OM. Ascending aortic dilatation associated with bicuspid aortic valve: pathophysiology, molecular biology, and clinical implications. Circulation 2009; 119 (06) 880-890
- 9 Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol 2010; 55 (25) 2789-2800
- 10 Michelena HI, Khanna AD, Mahoney D. et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA 2011; 306 (10) 1104-1112
- 11 Sannino A, Cedars A, Stoler RC, Szerlip M, Mack MJ, Grayburn PA. Comparison of efficacy and safety of transcatheter aortic valve implantation in patients with bicuspid versus tricuspid aortic valves. Am J Cardiol 2017; 120 (09) 1601-1606
- 12 Yoon SH, Bleiziffer S, De Backer O. et al. Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol 2017; 69 (21) 2579-2589
- 13 Vola M, Guichard JB, Fuzellier JF. et al. Sutureless valve implantation in Sievers type 0 bicuspid annuli: a word of caution. J Card Surg 2015; 30 (09) 694-696
- 14 Amr G, Ghoneim A, Giraldeau G, Demers P. First case of a sutureless Perceval valve delayed proximal migration. J Thorac Cardiovasc Surg 2017; 153 (02) e21-e23
- 15 Chiariello GA, Villa E, Messina A, Troise G. Dislocation of a sutureless prosthesis after type I bicuspid aortic valve replacement. J Thorac Cardiovasc Surg 2018; 156 (02) e87-e89
- 16 Santarpino G, Pfeiffer S, Fischlein T. Sutureless valve implantation in a patient with bicuspid aortic valve. Int J Cardiol 2012; 157 (02) e21-e22
- 17 Nguyen A, Fortin W, Mazine A. et al. Sutureless aortic valve replacement in patients who have bicuspid aortic valve. J Thorac Cardiovasc Surg 2015; 150 (04) 851-857
- 18 Baert J, Astarci P, Noirhomme P, de Kerchove L. The risk of oversizing with sutureless bioprosthesis in small aortic annulus. J Thorac Cardiovasc Surg 2017; 153 (02) 270-272
- 19 Cerillo AG, Amoretti F, Mariani M. et al. Increased gradients after aortic valve replacement with the Perceval valve: the role of oversizing. Ann Thorac Surg 2018; 106 (01) 121-128
- 20 Durdu MS, Gumus F, Ozcinar E. et al. Perceval sutureless valve replacement through a right anterior mini-thoracotomy in elderly patients with stenotic bicuspid aortic valve. Semin Thorac Cardiovasc Surg 2019; 31 (03) 458-464
- 21 Yoon SH, Maeno Y, Kawamori H. et al. Diagnosis and outcomes of transcatheter aortic valve implantation in bicuspid aortic valve stenosis. Interv Cardiol 2018; 13 (02) 62-65
- 22 de Kerchove L, Mastrobuoni S, Froede L. et al. Variability of repairable bicuspid aortic valve phenotypes: towards an anatomical and repair-oriented classification. Eur J Cardiothorac Surg 2019; 56: 351-359
- 23 Villa E, Messina A, Laborde F. et al. Challenge for Perceval: aortic valve replacement with small sutureless valves–a multicenter study. Ann Thorac Surg 2015; 99 (04) 1248-1254
- 24 Otto CM, Nishimura RA, Bonow RO. et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation 2021; 143 (05) e72-e227
- 25 Grayburn PA, Oh JK, Reardon MJ. et al. Effect of baseline aortic regurgitation on mortality in patients treated with transcatheter or surgical aortic valve replacement (from the CoreValve US Pivotal Trial). Am J Cardiol 2018; 122 (09) 1527-1535