BACKGROUND: Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. Anew concept of surgical sutureless (SU) bioprosthesis has been developed in the last decade. In this multi-institutional study we sought to compare hemodynamics of different bioprosthesis concept as transcatheter (TAVR), Livanova Perceval S sutureless valve and Freedom Solo Stentless (FS) valve in patients undergoing aortic valve replacement (sAVR). METHODS: From 2010 to 2016, 478 patients underwent sAVRwith FS, 518 Perceval S and 367 patients underwent TAVR. After a propensity matched analysis 185 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated. Echocardiographic hemodynamic data were also collected at 12 and 24 months. RESULTS: Mean prosthesis diameter was 23.8±1.3 mm for FS, 23.2±2.1 mm for Perceval S and 25.1±2.6 mm for TAVR. In-hospital mortality was 2.0% for FS, 1.9% for Perceval, 5.8% for TAVR(P=0.02). Postoperative FS peak gradients were 15.6±9.1 mmHg (mean 7.6±5.4 mmHg); SU gradients were 18.7±9.1 mmHg (mean 10.9±5.4 mmHg), TAVRpeak gradients were 14.7±9.1 mmHg (mean 6.1±5.4 mmHg) P=0.018 (P<0.001). Postoperative effective orifice area (EOA) was 1.94±0.7 cm2 for FS, 1.6±0.7 cm2 for SU and 1.97±0.7cm2 for TAVR(P<0.001). There was no prostheses-patient-mismatch (PPM) in FS group, while 4 cases and 2 cases are reported in SU and TAVRrespectively. Postoperative grade 2-3 paravalvular leak (PVL) was present in 4.3% for TAVRand 0.5% in SU valves and no cases in FS. Postoperative permanent pacemaker implant rate was 11.9% for TAVR(1.0%) in FS group and 5.4% in SU valves (P<0.001). CONCLUSIONS: SU patients demonstrated post-operative excellent hemodynamic performance with smaller EROAand higher gradients compared to FS and TAVR. TAVRdemonstrated higher mortality and pacemaker rates. Further studies are warrented to validate TAVRindications in this subset of patients.
Stentless sutureless and transcatheter valves: A comparison of the hemodynamic performance of different prostheses concept
Santarpino G.;
2018-01-01
Abstract
BACKGROUND: Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. Anew concept of surgical sutureless (SU) bioprosthesis has been developed in the last decade. In this multi-institutional study we sought to compare hemodynamics of different bioprosthesis concept as transcatheter (TAVR), Livanova Perceval S sutureless valve and Freedom Solo Stentless (FS) valve in patients undergoing aortic valve replacement (sAVR). METHODS: From 2010 to 2016, 478 patients underwent sAVRwith FS, 518 Perceval S and 367 patients underwent TAVR. After a propensity matched analysis 185 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated. Echocardiographic hemodynamic data were also collected at 12 and 24 months. RESULTS: Mean prosthesis diameter was 23.8±1.3 mm for FS, 23.2±2.1 mm for Perceval S and 25.1±2.6 mm for TAVR. In-hospital mortality was 2.0% for FS, 1.9% for Perceval, 5.8% for TAVR(P=0.02). Postoperative FS peak gradients were 15.6±9.1 mmHg (mean 7.6±5.4 mmHg); SU gradients were 18.7±9.1 mmHg (mean 10.9±5.4 mmHg), TAVRpeak gradients were 14.7±9.1 mmHg (mean 6.1±5.4 mmHg) P=0.018 (P<0.001). Postoperative effective orifice area (EOA) was 1.94±0.7 cm2 for FS, 1.6±0.7 cm2 for SU and 1.97±0.7cm2 for TAVR(P<0.001). There was no prostheses-patient-mismatch (PPM) in FS group, while 4 cases and 2 cases are reported in SU and TAVRrespectively. Postoperative grade 2-3 paravalvular leak (PVL) was present in 4.3% for TAVRand 0.5% in SU valves and no cases in FS. Postoperative permanent pacemaker implant rate was 11.9% for TAVR(1.0%) in FS group and 5.4% in SU valves (P<0.001). CONCLUSIONS: SU patients demonstrated post-operative excellent hemodynamic performance with smaller EROAand higher gradients compared to FS and TAVR. TAVRdemonstrated higher mortality and pacemaker rates. Further studies are warrented to validate TAVRindications in this subset of patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
