Sutureless aortic valve for reoperative aortic valve replacement as an alternative to composite graft replacement

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Degenerated biological aortic valve prosthesis with severe trans and paravalvular leaks and decompensated heart failure (NYHA class III) 13 years after a modified Bentall procedure (n=1). Intervention: Redo aortic valve replacement using a self-expandable sutureless aortic valve (Perceval size S) implanted inside the existing composite graft cuff. Primary outcome: Postoperative valve hemodynamics (peak/mean pressure gradient and paravalvular leak) and clinical status (NYHA functional class).

Taisuke Nakayama; Yoshitsugu Nakamura; Yuto Yasumoto; Borut Geršak

doi:10.1016/j.xjtc.2024.01.007

January 18, 2024JTCVS TechniquesOpen Access

Sutureless aortic valve for reoperative aortic valve replacement as an alternative to composite graft replacement

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Key result

Sutureless aortic valve implantation into a retained graft cuff eliminates paravalvular leak with favorable hemodynamics.

n=1

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Why the study?

Is redo aortic valve replacement using a sutureless aortic valve while leaving the previous prosthetic valve cuff and pledgets in place feasible as an alternative to redo composite graft replacement after a prior Bentall procedure?

Key Points

To report the feasibility of implanting a sutureless aortic valve within a degenerated composite graft to avoid full root re-replacement and coronary reimplantation.
Degenerated bioprosthetic leaflets and stent bands were excised while preserving the original sewing cuff and pledgets, followed by deployment of a size-S Perceval sutureless aortic valve.
The sutureless prosthesis was deployed successfully with an aortic crossclamp time of 66 minutes and a cardiopulmonary bypass time of 96 minutes.
Postoperative echocardiography confirmed absence of paravalvular leak, with peak and mean transvalvular gradients of 18 mm Hg and 9.4 mm Hg at 4 weeks that remained stable at 5 months.
The patient exhibited no atrioventricular block and improved from New York Heart Association functional class III preoperatively to class I at hospital discharge.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Is redo aortic valve replacement using a sutureless aortic valve while leaving the previous prosthetic valve cuff and pledgets in place feasible as an alternative to redo composite graft replacement after a prior Bentall procedure?

P

Population

1 male patient (aged 76 at initial surgery) presenting 13 years after a modified Bentall procedure with NYHA class III heart failure and severe trans/paravalvular leaks from a degenerated bioprosthetic conduit, followed for 5 months after redo surgery.

I

Intervention

Redo aortic valve replacement via median sternotomy using a self-expandable sutureless aortic valve (Perceval aortic pericardial heart valve, size S; Corcym) implanted inside the composite graft of the remnant sewing cuff and pledgets of the excised Carpentier-Edwards Perimount valve.

O

Outcome

Surgical feasibility, absence of paravalvular leak, postoperative hemodynamic performance (peak/mean pressure gradient), and NYHA functional class up to 5 months follow-up.surrogate

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Implication

Demonstrates the feasibility of implanting a sutureless aortic valve within the retained sewing cuff and pledgets of a degenerated Bentall composite graft to avoid high-risk redo aortic root replacement and coronary reimplantation.

Abstract

A 76-year-old man underwent a modified Bentall procedure in October 2010 for treatment of aortic regurgitation and annuloaortic ectasia. During that initial surgery, a bioprosthetic stented conduit, composed of a stented Carpentier-Edwards Perimount (CEP) 21-mm bioprosthesis (Edwards Lifesciences) and a Gelweave polyester straight prosthetic graft 26 mm in size (Terumo Cardiovascular Systems Inc), was placed directly by suturing to the native aortic annulus using everting Nespolen 2–0 mattress pledgeted sutures (Figure 1, A).

Discussion

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Cite This Study

Nakayama et al. (2024) conducted a case report in Degenerated biological aortic valve prosthesis with severe trans and paravalvular leaks and decompensated heart failure (NYHA class III) 13 years after a modified Bentall procedure (n=1). Redo aortic valve replacement using a self-expandable sutureless aortic valve (Perceval size S) implanted inside the existing composite graft cuff was evaluated on Postoperative valve hemodynamics (peak/mean pressure gradient and paravalvular leak) and clinical status (NYHA functional class). Sutureless aortic valve implantation inside a retained composite graft cuff eliminated paravalvular leakage and achieved a peak/mean gradient of 18/9.4 mm Hg at 4 weeks and 5 months.

synapsesocial.com/papers/6a75cb9eb5de85d41819c9c8 https://doi.org/10.1016/j.xjtc.2024.01.007

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Sutureless aortic valve for reoperative aortic valve replacement as an alternative to composite graft replacement

Figures

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sutureless aortic valve for reoperative aortic valve replacement as an alternative to composite graft replacement

Figures

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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