Giuseppe Santarpino1, Paolo Berretta2, Utz Kappert3, Kevin Teoh4, Carmelo Mignosa5, Bart Meuris6, Emmanuel Villa7, Alberto Albertini8, Thierry P Carrel9, Martin Misfeld10, Gianluca Martinelli11, Kevin Phan12, Antonio Miceli13, Thierry Folliguet14, Malak Shrestha15, Marco Solinas16, Martin Andreas17, Carlo Savini18, Tristan Yan19, Theodor Fischlein20, Marco Di Eusanio21. 1. Città di Lecce Hospital, GVM Care & Research, Lecce, Italy; Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Cardiac Surgery Unit, Department of Experimental and Clinical Medicine-University "Magna Graecia" of Catanzaro, Catanzaro, Italy. 2. Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy. Electronic address: p.berretta@icloud.com. 3. Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany. 4. Southlake Regional Health Centre, Ontario, Canada. 5. Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy. 6. Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium. 7. Poliambulanza Foundation Hospital, Brescia, Italy. 8. Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy. 9. Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland. 10. University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany. 11. Cardiovascular Department, Clinica San Gaudenzio, Novara, Italy. 12. The Collaborative Research (CORE) Group. 13. Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals, IRCCS Gruppo San Donato, Milan, Italy. 14. Henri Mondor Hospital, University of Paris, Paris, France. 15. Hannover Medical School, Hannover, Germany. 16. Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy. 17. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 18. Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy. 19. The Collaborative Research (CORE) Group; Macquarie University, Sydney, Australia. 20. Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany. 21. Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy; The Collaborative Research (CORE) Group.
Abstract
BACKGROUND: Reoperation for aortic valve replacement can be challenging and is usually associated with an increased risk for complications and mortality. The study aim was to report the results of a multicenter cohort of patients who underwent minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis. METHODS: From 2007 to 2018 data from 3651 patients were retrospectively collected from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry. Of them, 63 patients who had previously undergone cardiac surgery represented the study population. In-hospital clinical and echocardiographic outcomes were recorded. RESULTS: Mean age of the selected 63 patients was 75.3 ± 7.8 years and logistic EuroSCORE 10.1. Surgery was performed by ministernotomy in 43 patients (68.3%) and by anterior right thoracotomy in 20 (31.7%); 31 patients (49.2%) received the Perceval valve (Livanova PLC, London, UK) and 32 (50.8%) the Intuity valve (Edwards Lifesciences, Irvine, CA). Mean cross-clamp time was 57.8 ± 23.2 minutes and cardiopulmonary bypass time 95.0 ± 34.3 minutes. Neither conversion to full sternotomy nor in-hospital deaths occurred. Postoperative events were ischemic cerebral events in 3 patients (4.8%), need for pacemaker implantation in 2 (3.6%), bleeding requiring reoperation in 5 (8.9%), and dialysis in 1 (1.6%). Median intensive care unit stay was 1 day, and median length of hospital stay was 10 days. On echocardiographic evaluation 1 patient showed a significant postoperative aortic regurgitation. CONCLUSIONS: Minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis is a safe and feasible treatment strategy, resulting in fast recovery and improved postoperative outcome with no mortality and an acceptable complication rate.
BACKGROUND: Reoperation for aortic valve replacement can be challenging and is usually associated with an increased risk for complications and mortality. The study aim was to report the results of a multicenter cohort of patients who underwent minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis. METHODS: From 2007 to 2018 data from 3651 patients were retrospectively collected from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry. Of them, 63 patients who had previously undergone cardiac surgery represented the study population. In-hospital clinical and echocardiographic outcomes were recorded. RESULTS: Mean age of the selected 63 patients was 75.3 ± 7.8 years and logistic EuroSCORE 10.1. Surgery was performed by ministernotomy in 43 patients (68.3%) and by anterior right thoracotomy in 20 (31.7%); 31 patients (49.2%) received the Perceval valve (Livanova PLC, London, UK) and 32 (50.8%) the Intuity valve (Edwards Lifesciences, Irvine, CA). Mean cross-clamp time was 57.8 ± 23.2 minutes and cardiopulmonary bypass time 95.0 ± 34.3 minutes. Neither conversion to full sternotomy nor in-hospital deaths occurred. Postoperative events were ischemic cerebral events in 3 patients (4.8%), need for pacemaker implantation in 2 (3.6%), bleeding requiring reoperation in 5 (8.9%), and dialysis in 1 (1.6%). Median intensive care unit stay was 1 day, and median length of hospital stay was 10 days. On echocardiographic evaluation 1 patient showed a significant postoperative aortic regurgitation. CONCLUSIONS: Minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis is a safe and feasible treatment strategy, resulting in fast recovery and improved postoperative outcome with no mortality and an acceptable complication rate.
Authors: Michael L Williams; Campbell D Flynn; Andrew A Mamo; David H Tian; Utz Kappert; Manuel Wilbring; Thierry Folliguet; Antonio Fiore; Antonio Miceli; Augusto D'Onofrio; Giorgia Cibin; Gino Gerosa; Mattia Glauber; Theodor Fischlein; Francesco Pollari Journal: Ann Cardiothorac Surg Date: 2020-07