Giuseppe Santarpino1,2, Paolo Berretta3, Theodor Fischlein2, Thierry P Carrel4, Kevin Teoh5, Martin Misfeld6, Carlo Savini7, Utz Kappert8, Mattia Glauber9, Emmanuel Villa10, Bart Meuris11, Carmelo Mignosa12, Alberto Albertini13, Gianluca Martinelli14, Thierry A Folliguet15, Malak Shrestha16, Marco Solinas17, Günther Laufer18, Kevin Phan19, Tristan Yan19,20, Marco Di Eusanio19,21. 1. Città di Lecce Hospital, GVM Care & Research, Lecce, Italy. 2. Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany. 3. Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy. 4. Hospital Universitaire de Berne, Bern, Switzerland. 5. Southlake Regional Health Centre, ON, Canada. 6. University of Leipzig, Leipzig, Germany. 7. Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy. 8. Department of Cardiac Surgery, Dresden Heart Center, Dresden University Hospital, Dresden, Germany. 9. Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy. 10. Poliambulanza Foundation Hospital, Brescia, Italy. 11. Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium. 12. Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy. 13. GVM Care & Research, Cotignola, Italy. 14. Cardiovascular Department, Clinica San Gaudenzio, Novara, Italy. 15. Henri Mondor Hospital, University of Paris, Paris, France. 16. Hannover Medical School, Hannover, Germany. 17. Pasquinucci Heart Hospital, Massa, Italy. 18. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 19. The Collaborative Research (CORE) Group. 20. Macquarie University, Sydney, Australia. 21. Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy.
Abstract
OBJECTIVES: The ideal strategy for the treatment of severe aortic valve stenosis in patients of varying risk categories has become a debated topic in the last years: should the transcatheter or surgical approach be adopted? The aim of this study was to evaluate the outcomes of low-, intermediate-, high- and very high-risk patients undergoing sutureless, rapid deployment aortic valve replacement. METHODS: From 2007 to 2017, data on a total of 3651 patients were collected from the Sutureless and Rapid Deployment Aortic Valve Replacement International Registry (SURD-IR). Of these, 2057 patients who underwent primary isolated aortic valve replacement were considered for this analysis and classified as being at low (EuroSCORE <5; n = 500), intermediate (EuroSCORE 5-10; n = 901), high (EuroSCORE 11-20; n = 500) and very high (EuroSCORE >20; n = 156) preoperative risk. RESULTS: Overall, a less invasive approach was used in 74.1% of patients and represented the most frequent (>50%) approach in all risk categories. The Perceval prosthesis was used more frequently than other devices, especially in patients at high and very high risk. Hospital mortality was 1.6%, 0.8%, 1.9% and 2.7% in low-, intermediate-, high- and very high-risk patients, respectively, with no significant differences among subgroups. Similarly, postoperative complication rates were similar across the different risk categories. CONCLUSIONS: Surgical aortic valve replacement using sutureless, rapid deployment biological valve prostheses is associated with excellent results and represents a safe and effective treatment option for patients with severe aortic valve stenosis. This seems to be particularly true in patients with a higher risk profile.
OBJECTIVES: The ideal strategy for the treatment of severe aortic valve stenosis in patients of varying risk categories has become a debated topic in the last years: should the transcatheter or surgical approach be adopted? The aim of this study was to evaluate the outcomes of low-, intermediate-, high- and very high-risk patients undergoing sutureless, rapid deployment aortic valve replacement. METHODS: From 2007 to 2017, data on a total of 3651 patients were collected from the Sutureless and Rapid Deployment Aortic Valve Replacement International Registry (SURD-IR). Of these, 2057 patients who underwent primary isolated aortic valve replacement were considered for this analysis and classified as being at low (EuroSCORE <5; n = 500), intermediate (EuroSCORE 5-10; n = 901), high (EuroSCORE 11-20; n = 500) and very high (EuroSCORE >20; n = 156) preoperative risk. RESULTS: Overall, a less invasive approach was used in 74.1% of patients and represented the most frequent (>50%) approach in all risk categories. The Perceval prosthesis was used more frequently than other devices, especially in patients at high and very high risk. Hospital mortality was 1.6%, 0.8%, 1.9% and 2.7% in low-, intermediate-, high- and very high-risk patients, respectively, with no significant differences among subgroups. Similarly, postoperative complication rates were similar across the different risk categories. CONCLUSIONS: Surgical aortic valve replacement using sutureless, rapid deployment biological valve prostheses is associated with excellent results and represents a safe and effective treatment option for patients with severe aortic valve stenosis. This seems to be particularly true in patients with a higher risk profile.
Authors: Paolo Berretta; Luca Montecchiani; Fabio Vagnarelli; Mariano Cefarelli; Jacopo Alfonsi; Carlo Zingaro; Filippo Capestro; Michele D Pierri; Alessandro D'alfonso; Marco Di Eusanio Journal: Ann Cardiothorac Surg Date: 2020-09