Clinical outcomes after implantation of a sutureless aortic bioprosthesis with concomitant mitral valve surgery: the SURE-AVR registry
Por:
Baghai, M, Glauber, M, Fontaine, R, Castillo, JC, Walker, AH, Livi, U, Montiel, J, Royse, A, Bisleri, G, Pacini, D, Argano, V, Roumy, A, Asimakopoulos, G, Solinas, M, SURE AVR Investigators
Publicada:
30 may 2021
Resumen:
Background Early treatment of aortic valve stenosis is recommended in eligible symptomatic patients with severe aortic valve stenosis who would otherwise have a poor prognosis. The sutureless aortic valve bioprosthesis offers an alternative to standard aortic valve replacement with a sutured valve, but limited data are available in patients who have undergone multiple valve procedures involving the new, sutureless technology. We sought to investigate outcomes in high operative risk patients with previous or concomitant valve surgery who were implanted with a sutureless valve. Methods SURE-AVR is an ongoing, prospective, multinational registry of patients undergoing aortic valve replacement. In-hospital and post-discharge outcomes up to 5 years were collected. Results The study population comprised 78 patients (mean +/- SD: age 73.6 +/- 7.6 years, logistic EuroSCORE 18.0 +/- 17.5) enrolled at 13 sites who presented for concomitant or previous mitral valve repair (n = 45) or replacement (n = 33), with or without additional concomitant procedures, and were implanted with a sutureless valve. Mean +/- SD overall aortic cross-clamp time was 109 +/- 41 min and cardiopulmonary bypass time was 152 +/- 49 min. Mean +/- SD aortic pressure gradients decreased from 37.6 +/- 17.7 mmHg preoperatively to 13.0 +/- 5.7 mmHg at hospital discharge, and peak aortic pressure gradient from 61.5 +/- 28.7 to 23.4 +/- 10.6 mmHg. Early events included 1 death, 1 transient ischaemic attack, and 1 bleed (all 1.3%); a permanent pacemaker implantation was required in 6 patients (7.7%), and 2 reoperations (not valve related) (2.6%) took place. Over a median follow-up of 55.5 months (Q1 13.4, Q3 68.6), 12 patients died (6 cardiovascular and 6 non-cardiovascular, both 2.1% per patient-year). Five-year survival was 81.3%. Late paravalvular leak occurred in 2 patients (0.7% per patient-year) and permanent pacemaker implantation was required in 3 patients (0.1% per patient-year). There was no apparent rise in mean or peak aortic pressure gradient over the study. Conclusions These results suggest that the sutureless implant is a technically feasible procedure during mitral surgery and is associated with good clinical outcomes.
Filiaciones:
Baghai, M:
Kings Coll Hosp London, Dept Cardiovasc Med, London SE5 9RS, England
Glauber, M:
Ist Clin St Ambrogio, UO Cardiochirurg Mininvas, Milan, Italy
Fontaine, R:
Chirurg Cardiaque CHR Namur, Namur, Belgium
Castillo, JC:
Hosp Juan Canalejo, Cirugia Cardiaca, La Coruna, Spain
Walker, AH:
Blackpool Teaching Hosp NHS Fdn Trust, Cardiothorac Surg, Blackpool, England
Livi, U:
Az Osp Univ S Maria della Misericordia, Cardiochirurg, Udine, Italy
Montiel, J:
Hosp Santa Creu & Sant Pau, Cirurgia Cardiaca, Barcelona, Spain
Royse, A:
Univ Melbourne, Cardiovasc Dept, Melbourne, Vic, Australia
Bisleri, G:
Univ Toronto, Div Cardiac Surg, Toronto, ON, Canada
Pacini, D:
Policlin St Orsola, Cardiochiurg, Bologna, Italy
Argano, V:
AOU Policlin Paolo Giaccone, UOC Cardiochirurg, Palermo, Italy
Roumy, A:
CHU Vaudois, Serv Chirurg Cardiovasc, Lausanne, Switzerland
Asimakopoulos, G:
Royal Brompton Hosp, Heart Surg, London, England
Solinas, M:
Fdn Toscana Fabriele Monasterio, Osped Cuore G Pasquinucci, UOC Cardiochirurg Adulti, Massa, Italy
Green Published, gold
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