Perceval sutureless bioprosthesis versus Trifecta sutured bioprosthesis for aortic valve replacement: immediate results of the Perfecta study.

IF 0.6 Q4 SURGERY Kardiochirurgia I Torakochirurgia Polska Pub Date : 2024-09-01 Epub Date: 2024-09-25 DOI:10.5114/kitp.2024.143499
Paolo Nardi, Claudia Altieri, Calogera Pisano, Dario Buioni, Federico Agneni, Giorgia Grizzi, Martin Dakli, Alessandro Cristian Salvati, Mattia Scognamiglio, Carlo Bassano, Giovanni Ruvolo
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Abstract

Introduction: The Perceval sutureless biological prosthesis for aortic valve replacement has been introduced with the rationale for shortening surgical, extracorporeal circulation and aortic cross-clamping times, in order to reduce postoperative complications.

Aim: To evaluate early hemodynamic performance and immediate outcomes of implantation of the Perceval sutureless bioprosthesis in comparison with the St. Jude Trifecta sutured bioprosthesis for aortic valve replacement (Perfecta study).

Material and methods: Between December 2014 and June 2023, 281 patients underwent St. Jude Trifecta implantation (n = 220, mean age: 75.2 ±6.5 years) and Perceval implantation, when indicated (n = 61, mean age: 77.9 ±5.1 years). Concomitant CABG was performed in 73 (33%) and in 27 (44%) patients, respectively.

Results: Extracorporeal circulation and cross-clamp times were significantly shorter in Perceval patients in all aortic valve replacements (61 ±23 and 49 ±18 minutes vs. 96 ±36 and 67 ±21 minutes), and in isolated procedures (54 ±10 and 43 ±8 minutes vs. 84 ±28 and 66 ±21 minutes) (p < 0.0001, for all comparisons). Operative mortality was absent and 2.7%, respectively (p = 0.2). Postoperatively, low output cardiac syndrome (0% vs. 4.5%) and total rate of major cardiac and non-cardiac related complications (6.6% vs. 18.6%) were significantly lower in Perceval patients (p = 0.01). Echocardiography at discharge in comparison with preoperatively showed a relevant and similar decrease of mean and peak trans-aortic valve gradients for the Trifecta prosthesis (11.6 ±4.3 vs. 50 ±15.2 mm Hg; 21.6 ±7.3 vs. 78.8 ±24 mm Hg) and for the Perceval prosthesis (12.6 ±4.8 vs. 52 ±12.5 mm Hg; 22.6 ±7.9 vs. 77.8 ±16 mm Hg) (p < 0.00001, for all comparisons). Better global cardiac function was observed in Perceval patients. Concomitant multi-vessel and left main coronary artery disease (p = 0.046; HR = 4.6) and chronic pulmonary disease (p = 0.006; HR = 5.6) were detected as independent predictors of death and postoperative major complications.

Conclusions: Early hemodynamic performance appears to be satisfactory with the use of Trifecta sutured and Perceval sutureless bioprostheses. Perceval implantation allows reduction of surgical times, better preservation of myocardial contractile function and, consequently, reduction of the risk of postoperative complications.

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在主动脉瓣置换术中,Perceval 无缝合生物瓣膜与 Trifecta 有缝合生物瓣膜的对比:Perfecta 研究的即时结果。
简介:目的:评估Perceval无缝合生物人工瓣膜与St. Jude Trifecta有缝合生物人工瓣膜在主动脉瓣置换术中的早期血流动力学表现和近期疗效比较(Perfecta研究).材料和方法:2014年12月至2023年6月期间,281名患者接受了St. Jude Trifecta人工瓣膜植入术(n = 220)和Perceval人工瓣膜植入术(n = 220):2014年12月至2023年6月期间,281名患者接受了St. Jude Trifecta植入术(n = 220,平均年龄:75.2 ± 6.5岁)和Perceval植入术(n = 61,平均年龄:77.9 ± 5.1岁)。分别有 73 例(33%)和 27 例(44%)患者同时进行了 CABG:在所有主动脉瓣置换术中,Perceval 患者的体外循环和交叉钳夹时间明显缩短(61 ±23 分钟和 49 ±18 分钟 vs. 96 ±36 分钟和 67 ±21 分钟),在孤立手术中,体外循环和交叉钳夹时间也明显缩短(54 ±10 分钟和 43 ±8 分钟 vs. 84 ±28 分钟和 66 ±21 分钟)(所有比较中,P < 0.0001)。手术死亡率分别为0.7%和2.7%(P = 0.2)。术后,低输出量心脏综合征(0% 对 4.5%)和主要心脏和非心脏相关并发症总发生率(6.6% 对 18.6%)在 Perceval 患者中明显较低(p = 0.01)。出院时的超声心动图显示,与术前相比,Trifecta 人工瓣膜的平均和经主动脉瓣梯度峰值均有相关的相似下降(11.6 ±4.3 vs. 50 ±15.2 mm Hg; 21.6 ±7.3 vs. 78.8 ±24 mm Hg)和 Perceval 人工瓣膜(12.6 ±4.8 vs. 52 ±12.5 mm Hg; 22.6 ±7.9 vs. 77.8 ±16 mm Hg)的经主动脉瓣梯度平均值和峰值下降幅度相似(所有比较中,P < 0.00001)。在 Perceval 患者中观察到更好的整体心脏功能。同时发现多血管和左主干冠状动脉疾病(p = 0.046;HR = 4.6)和慢性肺部疾病(p = 0.006;HR = 5.6)是死亡和术后主要并发症的独立预测因素:结论:使用Trifecta缝合生物前列腺假体和Perceval无缝合生物前列腺假体的早期血流动力学表现似乎令人满意。Perceval植入可缩短手术时间,更好地保护心肌收缩功能,从而降低术后并发症的风险。
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来源期刊
CiteScore
0.90
自引率
14.30%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Polish Journal of Thoracic and Cardiovascular Surgery is a quarterly aimed at cardiologists, cardiosurgeons and thoracic surgeons. Includes the original works (experimental, research and development), illustrative and casuistical works about cardiology and cardiosurgery.
期刊最新文献
Clinicodemographic profile and outcomes of congenital diaphragmatic hernia with sac: experience of a paediatric referral centre. Comparison of the effect of chest tube diameter on drainage rate and tube performance in patients with pleural effusion. A cross-sectional study. Enhancing treatment approaches for postpneumonectomy empyema: exploring the role of video-assisted thoracic surgery. Optimal timing of percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction presenting late. Perceval sutureless bioprosthesis versus Trifecta sutured bioprosthesis for aortic valve replacement: immediate results of the Perfecta study.
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