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Published on: May 21, 2017
Risk predictors that impact long-term prognosis in patients undergoing aortic valve replacement with the Perceval
Aleksander Dokollari1, Rafik Margaryan2, Gianluca Torregrossa3
1Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands; Lankenau Institute for Medical Research, United States of America.
Insights
This study on Perceval sutureless bioprosthesis aortic valve replacement found good clinical outcomes. Female sex and left ventricular diastolic dysfunction grade 2 or higher predict all-cause mortality in these patients.
Area of Science:
- Cardiovascular Surgery
- Bioprosthetic Valves
- Surgical Outcomes
Background:
- Aortic valve replacement (AVR) is a critical procedure for patients with aortic valve disease.
- Sutureless bioprosthetic valves, like the Perceval prosthesis, offer an alternative implantation technique.
- Identifying predictors of long-term prognosis after isolated AVR is essential for patient management.
Purpose of the Study:
- To identify risk predictors impacting long-term prognosis in patients undergoing isolated AVR with the Perceval sutureless bioprosthesis.
- To analyze all-cause mortality as the primary endpoint.
- To compare outcomes of redo sutureless AVR versus redo sutured AVR.
Main Methods:
- A cohort of 101 consecutive patients undergoing isolated AVR with the Perceval sutureless bioprosthesis (2013-2020) was analyzed.
- Propensity-adjusted analysis compared redo sutureless AVR with redo sutured AVR.
- All-cause mortality was the primary endpoint, with a mean follow-up of 1.5 years.
Main Results:
- Mean patient age was 71.2 years, with a mean EuroScore II of 3.51.
- At 7-year follow-up, 87.9% of patients were alive.
- Risk predictors for all-cause death were identified as female sex and left ventricular diastolic dysfunction (LVDD) grade ≥ 2.
Conclusions:
- Perceval sutureless aortic valve implantation demonstrates favorable clinical outcomes.
- Female sex and LVDD grade ≥ 2 are significant risk predictors for all-cause mortality.
- Sutureless valves may offer advantages in redo procedures, with lower rates of complications.
Background:
The aim of this study is to identify risk predictors that impact long-term prognosis in patients undergoing isolated aortic valve replacement (AVR) with Perceval sutureless bioprosthesis aortic valve implantation.
Methods:
From 2013 to 2020, 101 consecutive participants who underwent isolated AVR with the Perceval sutureless bioprosthesis were included. Primary endpoint was analysis of all-cause mortality. We performed a propensity-adjusted analysis of patients undergoing redo sutureless vs redo sutured AVR to understand the impact of sutureless valves in redo operations.
Results:
Pre-operative characteristics included a mean age of 71.2-years, mean EuroScore II of 3.51 (±4.48), mean body mass index of 30.2 (±6.8). Mean follow-up was 1.5 years. Intraoperatively, mean cardiopulmonary bypass time and aortic cross-clamp time were 65 ± 29.6 and 47.3 ± 21.3 min, respectively. Valve redeployment was necessary in 9.9 % of cases and there was one intraoperative death. There were two hospital deaths (including the operative death) while only one was cardiac related. Postoperatively, mean ejection fraction was 55.5 % (±4.1 %), mean effective orifice was 1.5 (±0.3) cm2, and mean transvalvular gradient was 14.7 (±4) mmHg. At 7-years follow-up, 87.9 % of patients were alive. Risk predictors for all-cause death were female sex and left ventricular diastolic dysfunction (LVDD) grade ≥ 2. After matching, aortic cross-clamp time, inotrope use, blood product transfusions, respiratory failure, and post-operative arrhythmias were higher in the redo sutured group compared to the sutureless redo group.
Conclusions:
Sutureless aortic valve implantations have good clinical outcomes. Risk predictors for all-cause death included female sex and LVDD grade ≥ 2.
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