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Comparison of Perioperative Results of Sutureless and Conventional Valves in Aortic Valve Replacement Surgery

Yıl 2020, Cilt: 23 Sayı: 2, 102 - 110, 16.08.2020

Öz

Introduction: This study aimed to evaluate the early and midterm results of sutureless and conventional bioprosthetic valves in patients who underwent aortic valve replacement (AVR) due to aortic stenosis.

Patients and Methods: Patients who underwent a bioprosthetic AVR due to aortic stenosis in our institution between 2012 and 2017 were included in our study. The patients were divided into two groups on the basis of type of aortic valve prosthesis used as a sutureless valve (SU-AVR) (n= 62) and a conventional valve (CAVR) (n= 69).

Results: The EuroSCORE II in the sutureless group was found to be significantly higher as compared to the conventional group (p= 0.0121). Patients in the sutureless group underwent more mini-incisional approaches: 22 (36%) versus 4 (6%, p= 0.0002). The mean aortic cross-clamp and cardiopulmonary bypass time were significantly lower in the sutureless group as compared to the conventional one (53.8 ± 34.2 vs. 79.2 ± 36.3 minutes and 87.5 ± 40.7 vs. 117.4 ± 66.3 minutes, p< 0.0001). The mean follow-up time was 19.5 ± 15.7 months in the sutureless group and 28.0 ± 21.0 months in the conventional group. The overall survival rate of the sutureless and the conventional group was found to be 72.6% and 78.3%, respectively, (p= 0.253) when Kaplan-Meier analysis was done.

Conclusion: Although SU-AVR patients are found to have a higher preoperative risk score compared to the conventional group, yet it can be performed with comparable mortality and morbidity to C-AVR. Therefore, SUAVR is a promising alternative to C-AVR, especially in elderly and high-risk patients with comorbid diseases.

Kaynakça

  • 1. Carabello BA, Paulus WJ. Aortic stenosis. The Lancet 2009;373:956-66.
  • 2. Brown JM, O’Brien SM, Wu C, Sikora JAH, Griffith BP, Gammie JS. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg 2009;137:82-90.
  • 3. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012;33:2451-96.
  • 4. Flameng WJ, Herijgers P, Szecsi J, Sergeant PT, Daenen WJ, Scheys I. Determinants of early and late results of combined valve operations and coronary artery bypass grafting. Ann Thorac Surg 1996;61:621-8.
  • 5. Ranucci M, Frigiola A, Menicanti L, Castelvecchio S, de Vincentiis C, Pistuddi V. Aortic cross-clamp time, new prostheses, and outcome in aortic valve replacement. J Heart Valve Dis 2012;21:732-9.
  • 6. Shrestha M, Maeding I, Höffler K, Koigeldiyev N, Marsch G, Siemeni T, et al. Aortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future?. Interactive Cardiovasc Thorac Surg 2013;17:778-82.
  • 7. Hurley ET, O’Sullivan KE, Segurado R, Hurley JP. A meta-analysis examining differences in short-term outcomes between sutureless and conventional aortic valve prostheses. Innovations (Phila) 2015;10:375-82.
  • 8. Laborde F, Fischlein T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, et al. Clinical and hemodynamic 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 2015;49:978-86.
  • 9. Thalji NM, Suri RM, Michelena HI, Greason KL, Dearani JA, Daly RC, et al. Do differences in early hemodynamic performance of current generation biologic aortic valves predict outcomes 1 year following surgery? J Thorac Cardiovasc Surg 2015;149:163-73.
  • 10. Haverich A, Wahlers TC, Borger MA, Shrestha M, Kocher AA, Walther T, et al. Three-year hemodynamic performance, left ventricular mass regression, and prosthetic-patient mismatch after rapid deployment aortic valve replacement in 287 patients. J Thorac Cardiovasc Surg 2014;148:2854-61.
  • 11. Bavaria JE, Desai ND, Cheung A, Petracek MR, Groh MA, Borger MA, et al. The St Jude Medical Trifecta aortic pericardial valve: results from a global, multicenter, prospective clinical study. J Thorac Cardiovasc Surg 2014;147:590-7.
  • 12. Shrestha M, Fischlein T, Meuris B, Flameng W, Carrel T, Madonna F, et al. European multicentre experience with the sutureless Perceval valve: clinical and hemodynamic outcomes up to 5 years in over 700 patients. Eur J Cardiothorac Surg 2015;49:234-41.
  • 13. Shrestha M. Do we need sutureless or self-anchoring aortic valve prostheses? Ann Cardiothorac Surg 2015;4:175.
  • 14. Mazine A, Teoh K, Bouhout I, Bhatnagar G, Pelletier M, Voisine P, et al. Sutureless aortic valve replacement: a Canadian multicentre study. Canadian J Cardiol 2015;31:63-8.
  • 15. Di Eusanio M, Phan K, Berretta P, Carrel TP, Andreas M, Santarpino G, et al. Sutureless and Rapid-Deployment aortic valve replacement international registry (SURD-IR): early results from 3343 patients. Eur J Cardiothorac Surg 2018;54:768-73.
  • 16. Shalabi A, Spiegelstein D, Sternik L, Feinberg MS, Kogan A, Levin S, et al. Sutureless versus stented valve in aortic valve replacement in patients with small annulus. Ann Thorac Surg 2016;102:118-22.
  • 17. Ensminger S, Fujita B, Bauer T, Möllmann H, Beckmann A, Bekeredjian R, et al. Rapid deployment versus conventional bioprosthetic valve replacement for aortic stenosis. J Am Coll Cardiol 2018;71:1417-28.
  • 18. Sohn SH, Jang MJ, Hwang HY, Kim KH. Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: a meta-analysis. J Thorac Cardiovasc Surg 2018;155:2402-12.

Aort Kapak Replasmanı Cerrahisinde Dikişsiz Kapaklar ile Konvansiyonel Kapakların Perioperatif Sonuçlarının Karşılaştırılması

Yıl 2020, Cilt: 23 Sayı: 2, 102 - 110, 16.08.2020

Öz

Giriş: Bu çalışmanın amacı, aort kapak darlığı nedeniyle aort kapak replasmanı (AVR) uygulanan hastalarda dikişsiz ve konvansiyonel biyoprotez kapakların erken ve orta dönem sonuçlarını değerlendirmektir.

Hastalar ve Yöntem: Çalışmaya kliniğimizde 2012-2017 yılları arasında aort darlığı nedeniyle biyoprotez AVR uygulanan hastalar dahil edildi. Hastalar kullanılan aort kapak protez tipine göre dikişsiz kapak (n= 62) ve konvansiyonel kapak (n= 69) olarak iki gruba ayrıldı.

Bulgular: EuroSCORE II dikişsiz grupta konvansiyonel gruba göre anlamlı derecede yüksek olarak hesaplanmıştır (p= 0.0121). Mini insizyonel yaklaşım dikişsiz grupta 22 (%36) hastaya uygulanmışken, konvansiyonel grupta 4 (%6) hastaya uygulanmıştır (p= 0.0002). Ortalama aortik kros klemp ve kardiyopulmoner baypas süreleri dikişsiz grupta konvansiyonel gruba göre anlamlı olarak daha düşük bulunmuştur (53.8 ± 34.2’ye karşı 79.2 ± 36.3 dk ve 87.5 ± 40.7’ye karşı 117.4 ± 66.3 dk, p< 0.0001). Ortalama takip süresi dikişsiz grupta 19.5 ± 15.7 ay iken konvansiyonel grupta 28.0 ± 21.0 idi. Kaplan-Meire sağkalım analizi yaptığımızda tüm nedenlere bağlı ölümler hesaba katıldığında dikişsiz kapak grubunda genel sağkalım oranının %72.6, konvansiyonel kapak grubunda ise %78.3 olduğu bulunmuştur (p= 0.253).

Sonuç: Dikişsiz AVR konvansiyonel AVR’ye göre daha yüksek preoperatif risk skoruna sahip hastalarda uygulanıyor olmasına karşın, konvansiyonel AVR ile karşılaştırılabilir mortalite ve morbidite ile uygulanabilir. Bu nedenle, dikişsiz AVR özellikle komorbid hastalıkları olan yaşlı ve yüksek riskli hastalarda konvansiyonel AVR’ye umut verici bir alternatif gibi görünmektedir.

Kaynakça

  • 1. Carabello BA, Paulus WJ. Aortic stenosis. The Lancet 2009;373:956-66.
  • 2. Brown JM, O’Brien SM, Wu C, Sikora JAH, Griffith BP, Gammie JS. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg 2009;137:82-90.
  • 3. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012;33:2451-96.
  • 4. Flameng WJ, Herijgers P, Szecsi J, Sergeant PT, Daenen WJ, Scheys I. Determinants of early and late results of combined valve operations and coronary artery bypass grafting. Ann Thorac Surg 1996;61:621-8.
  • 5. Ranucci M, Frigiola A, Menicanti L, Castelvecchio S, de Vincentiis C, Pistuddi V. Aortic cross-clamp time, new prostheses, and outcome in aortic valve replacement. J Heart Valve Dis 2012;21:732-9.
  • 6. Shrestha M, Maeding I, Höffler K, Koigeldiyev N, Marsch G, Siemeni T, et al. Aortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future?. Interactive Cardiovasc Thorac Surg 2013;17:778-82.
  • 7. Hurley ET, O’Sullivan KE, Segurado R, Hurley JP. A meta-analysis examining differences in short-term outcomes between sutureless and conventional aortic valve prostheses. Innovations (Phila) 2015;10:375-82.
  • 8. Laborde F, Fischlein T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, et al. Clinical and hemodynamic 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 2015;49:978-86.
  • 9. Thalji NM, Suri RM, Michelena HI, Greason KL, Dearani JA, Daly RC, et al. Do differences in early hemodynamic performance of current generation biologic aortic valves predict outcomes 1 year following surgery? J Thorac Cardiovasc Surg 2015;149:163-73.
  • 10. Haverich A, Wahlers TC, Borger MA, Shrestha M, Kocher AA, Walther T, et al. Three-year hemodynamic performance, left ventricular mass regression, and prosthetic-patient mismatch after rapid deployment aortic valve replacement in 287 patients. J Thorac Cardiovasc Surg 2014;148:2854-61.
  • 11. Bavaria JE, Desai ND, Cheung A, Petracek MR, Groh MA, Borger MA, et al. The St Jude Medical Trifecta aortic pericardial valve: results from a global, multicenter, prospective clinical study. J Thorac Cardiovasc Surg 2014;147:590-7.
  • 12. Shrestha M, Fischlein T, Meuris B, Flameng W, Carrel T, Madonna F, et al. European multicentre experience with the sutureless Perceval valve: clinical and hemodynamic outcomes up to 5 years in over 700 patients. Eur J Cardiothorac Surg 2015;49:234-41.
  • 13. Shrestha M. Do we need sutureless or self-anchoring aortic valve prostheses? Ann Cardiothorac Surg 2015;4:175.
  • 14. Mazine A, Teoh K, Bouhout I, Bhatnagar G, Pelletier M, Voisine P, et al. Sutureless aortic valve replacement: a Canadian multicentre study. Canadian J Cardiol 2015;31:63-8.
  • 15. Di Eusanio M, Phan K, Berretta P, Carrel TP, Andreas M, Santarpino G, et al. Sutureless and Rapid-Deployment aortic valve replacement international registry (SURD-IR): early results from 3343 patients. Eur J Cardiothorac Surg 2018;54:768-73.
  • 16. Shalabi A, Spiegelstein D, Sternik L, Feinberg MS, Kogan A, Levin S, et al. Sutureless versus stented valve in aortic valve replacement in patients with small annulus. Ann Thorac Surg 2016;102:118-22.
  • 17. Ensminger S, Fujita B, Bauer T, Möllmann H, Beckmann A, Bekeredjian R, et al. Rapid deployment versus conventional bioprosthetic valve replacement for aortic stenosis. J Am Coll Cardiol 2018;71:1417-28.
  • 18. Sohn SH, Jang MJ, Hwang HY, Kim KH. Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: a meta-analysis. J Thorac Cardiovasc Surg 2018;155:2402-12.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Araştırmalar
Yazarlar

Fatih Öztürk Bu kişi benim 0000-0002-3549-005X

Taylan Adademir Bu kişi benim 0000-0003-1643-3751

Veysel Başar Bu kişi benim 0000-0001-5478-0266

Osman Türe Bu kişi benim 0000-0002-2261-0294

Davut Çekmecelioğlu Bu kişi benim 0000-0003-1946-326X

Mehmet Şengör Bu kişi benim 0000-0003-3253-2936

Hızır Alp Bu kişi benim 0000-0002-9608-2316

Yayımlanma Tarihi 16 Ağustos 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 23 Sayı: 2

Kaynak Göster

Vancouver Öztürk F, Adademir T, Başar V, Türe O, Çekmecelioğlu D, Şengör M, Alp H. Comparison of Perioperative Results of Sutureless and Conventional Valves in Aortic Valve Replacement Surgery. Koşuyolu Heart Journal. 2020;23(2):102-10.