Elisabet Berastegui García1, Maria Luisa Camara Rosell1, Francisco Estevez Cid2, Eladio Sanchez Dominguez3, Remedios Rios Barrera4, Fabrizio Sbraga5, Julio Garcia Puente6, Elena Rosello Diez7, Gregorio Pablo Cuerpo Caballero8, Juan Bustamante Munguira1,9, Guillermo Reyes Copa9, Marian Tena Pajuelo10, Santiago Serrano Fiz11, Jose Alfonso Buendía Miñano12, Ivan García Martin13, Jose Cuenca Castillo2, Sergio Cánovas Lopez6, Angel Gonzalez Pinto8, Xavier Ruyra Baliarda1. 1. Department of Cardiac Surgery, Hospital Germans Trias i Pujol, Badalona, Spain. 2. Department of Cardiac Surgery, Complejo Hospitalario Universitario A Coruña, CHUAC, A Coruña, Spain. 3. Department of Cardiac Surgery, Hospital Infanta Cristina - Badajoz, Badajoz, Spain. 4. Department of Cardiac Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 5. Department of Cardiac Surgery, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain. 6. Department of Cardiac Surgery, Hospital Universitario Virgen de la Arraixaca, Murcia, Spain. 7. Department of Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 8. Department of Cardiac Surgery, Hospital Universitario Gregorio Marañon, Madrid, Spain. 9. Department of Cardiac Surgery, Hospital Universitario La Princesa, Madrid, Spain. 10. Department of Cardiac Surgery, Hospital Universitario Dr. Negrin, Las Palmas, Spain. 11. Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro, Madrid, Spain. 12. Department of Cardiac Surgery, Hospital Universitario Virgen de la Salud - Toledo, Toledo, Spain. 13. Department of Cardiac Surgery, Hospital Universitario Marques de Valdecilla (HUMV), Santander, Spain.
Abstract
OBJECTIVES: The development of new percutaneous and surgical techniques has reduced the risk associated with aortic valve replacement procedures. We present the results of a Spanish register after initiating a programme for sutureless prostheses in moderate-high-risk patients. METHODS: This prospective multicentre study was carried out from November 2013 to November 2016. Data were obtained from 448 patients in whom a Perceval S prosthesis was implanted. RESULTS: The mean age was 79.24 (standard deviation [SD] 4.1) years, and 61.2% were women. The estimated EuroSCORE I log risk was 11.15% (SD 7.6), with an observed mortality of 4.4% (20 patients). Isolated aortic valve replacement was performed on 69.26% of patients, with 64% involving ministernotomy. The incidence of neurological events was 2%, with 2 permanent cerebrovascular accidents, and 41 (9.2%) patients were implanted with a permanent endocavitary pacemaker. At discharge, 12 (2.6%) patients presented minimal periprosthetic leakage, and 4 (0.89%) patients had moderate leakage. There were 3 reinterventions during follow-up (2 endocarditis and 1 dysfunction due to periprosthetic leak progression). The mean gradient at discharge, 6 months and 1 year was 12.94 (SD 5.3) mmHg, 12.19 (SD 4.7) mmHg and 11.77 (SD 4.7) mmHg, respectively; 59.4% of the patients were octogenarians, with a survival rate of 98% at both 6 months and 1 year at discharge. There was neither valve migration nor early structural degeneration. The mean follow-up was 12 ± 3 months. The 6-month and 1-year mortality was 1.4% and 2.1%, respectively. CONCLUSIONS: This is a prospective multicentric study on the largest cohort of patients with sutureless valves conducted in Spain to date. It is a reproducible procedure that has enabled surgery on patients with a moderate-high risk with low morbidity and mortality, providing good haemodynamic results.
OBJECTIVES: The development of new percutaneous and surgical techniques has reduced the risk associated with aortic valve replacement procedures. We present the results of a Spanish register after initiating a programme for sutureless prostheses in moderate-high-risk patients. METHODS: This prospective multicentre study was carried out from November 2013 to November 2016. Data were obtained from 448 patients in whom a Perceval S prosthesis was implanted. RESULTS: The mean age was 79.24 (standard deviation [SD] 4.1) years, and 61.2% were women. The estimated EuroSCORE I log risk was 11.15% (SD 7.6), with an observed mortality of 4.4% (20 patients). Isolated aortic valve replacement was performed on 69.26% of patients, with 64% involving ministernotomy. The incidence of neurological events was 2%, with 2 permanent cerebrovascular accidents, and 41 (9.2%) patients were implanted with a permanent endocavitary pacemaker. At discharge, 12 (2.6%) patients presented minimal periprosthetic leakage, and 4 (0.89%) patients had moderate leakage. There were 3 reinterventions during follow-up (2 endocarditis and 1 dysfunction due to periprosthetic leak progression). The mean gradient at discharge, 6 months and 1 year was 12.94 (SD 5.3) mmHg, 12.19 (SD 4.7) mmHg and 11.77 (SD 4.7) mmHg, respectively; 59.4% of the patients were octogenarians, with a survival rate of 98% at both 6 months and 1 year at discharge. There was neither valve migration nor early structural degeneration. The mean follow-up was 12 ± 3 months. The 6-month and 1-year mortality was 1.4% and 2.1%, respectively. CONCLUSIONS: This is a prospective multicentric study on the largest cohort of patients with sutureless valves conducted in Spain to date. It is a reproducible procedure that has enabled surgery on patients with a moderate-high risk with low morbidity and mortality, providing good haemodynamic results.