Single-Center, Multisurgeon Experience with a Sutureless Rapid Deployment Aortic Valve Prosthesis: A Clinical Analysis in the United States

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiac Surgery Pub Date : 2023-07-10 DOI:10.1155/2023/4827516
M. Robich, K. Ohlrich, Catherine Raymer, D. Robaczewski, J. Rabb, D. Radziszewski, A. Iribarne, S. Seshasayee, C. Ross, R. Quinn, R. Kramer
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Abstract

Background. The Perceval S is a sutureless, bovine pericardial aortic prosthesis on a nitinol stent, which has limited data on outcomes, as well as cost, from the United States. Methods. We performed a retrospective review of Perceval S implantation at a single center between 2015 and 2018. After exclusion criteria, we compared 234 patients who underwent sutureless aortic valve (SLV) implantation with 370 patients who underwent standard sutured aortic valves (SAVR). Hospital cost data were reviewed, and risk adjustment, done by propensity score and inverse probability weighting, was used to compare outcomes. Results. Compared to those undergoing SAVR, the SLV group was older and had a higher proportion of multicomponent operations, higher preoperative white blood cell count, higher rate of previous percutaneous coronary interventions, more comorbid conditions (diabetes, renal insufficiency, and dialysis), and more three-vessel coronary disease. For isolated AVR, partial upper hemisternotomy was more frequent in SLV. The mean cardiopulmonary bypass and cross-clamp times for isolated SLV were significantly lower than SAVR. After adjustment, the cohort was balanced. Operative differences for SLV were lower cross-clamp and pump time, larger valve size, more minimally invasive approaches, and shorter operating room times. There were no differences in other postoperative complications (postoperative atrial fibrillation, stroke, renal failure, prolonged ventilation, and in-hospital mortality; p > 0.05 for all). Mean and median hospital costs were higher in the SLV group, largely due to the cost of the implant. Conclusion. Sutureless tissue aortic valves can be used safely with lower cardiopulmonary bypass and clamp times than sutured prostheses and facilitate use of minimally invasive approaches. This valve may be advantageous in older, higher risk patients requiring more complex operations.
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无缝合快速展开主动脉瓣人工瓣膜的单中心、多手术经验:美国临床分析
背景Perceval S是一种在镍钛诺支架上的无缝合牛心包主动脉假体,美国的结果和成本数据有限。方法。我们对2015年至2018年间在一个中心进行的Perceval S植入进行了回顾性审查。在排除标准之后,我们比较了234例接受无缝合主动脉瓣(SLV)植入术的患者和370例接受标准缝合主动脉瓣的患者。回顾了医院成本数据,并使用倾向评分和逆概率加权进行风险调整来比较结果。后果与接受SAVR的患者相比,SLV组年龄更大,多组分手术的比例更高,术前白细胞计数更高,既往经皮冠状动脉介入治疗的比率更高,合并症(糖尿病、肾功能不全和透析)更多,三血管冠状动脉疾病更多。对于孤立性AVR,SLV中胸骨上半部分切开术更为常见。孤立SLV的平均心肺转流和交叉夹持时间显著低于SAVR。经过调整后,队列达到平衡。SLV的手术差异在于交叉夹紧和泵送时间较短,瓣膜尺寸较大,微创入路较多,手术室时间较短。其他术后并发症(术后心房颤动、中风、肾功能衰竭、长期通气和住院死亡率)没有差异;所有患者均p>0.05。SLV组的平均住院费用和中位数较高,这主要是由于植入物的成本。结论与缝合假体相比,无缝合组织主动脉瓣可以安全地使用,心肺转流和夹紧时间更短,并有助于微创方法的使用。这种瓣膜可能有利于需要更复杂手术的老年高危患者。
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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