Surgical aortic valve replacement with new-generation bioprostheses: Sutureless versus rapid-deployment

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 159; no. 2; pp. 432 - 442.e1
• Main Authors: D'Onofrio, Augusto, Salizzoni, Stefano, Filippini, Claudia, Tessari, Chiara, Bagozzi, Lorenzo, Messina, Antonio, Troise, Giovanni, Tomba, Margerita Dalla, Rambaldini, Manfredo, Dalén, Magnus, Alamanni, Francesco, Massetti, Massimo, Mignosa, Carmelo, Russo, Claudio, Salvador, Loris, Di Bartolomeo, Roberto, Maselli, Daniele, De Paulis, Ruggero, Alfieri, Ottavio, De Filippo, Carlo Maria, Portoghese, Michele, Bortolotti, Uberto, Rinaldi, Mauro, Gerosa, Gino
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2020
• Subjects: aortic valve; Medicin och hälsovetenskap; rapid deployment aortic bioprosthesis; replacement; sutureless aortic bioprosthesis; rapid deployment aortic bioprosthesis; aortic valve; sutureless aortic bioprosthesis; STS; EuroSCORE; INTU-ITA; VARC-2; replacement; AVR
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2019.02.135

The aim of this retrospective multicenter study was to compare early clinical and hemodynamic outcomes of Perceval-S sutureless (Livanova, London, United Kingdom) and Intuity rapid-deployment (Edwards Lifesciences, Irvine, Calif) bioprostheses. Data from patients who underwent isolated or combined aortic valve replacement with Perceval-S and with Intuity bioprostheses at 18 cardiac surgical institutions were analyzed. Propensity matching was performed to identify similar patient cohorts. We included 911 patients from March 2011 until May 2017. Perceval-S and Intuity valves were implanted in 349 (38.3%) and in 562 (61.7%) patients, respectively. Propensity score identified 117 matched pairs. In the matched cohort, device success was 99.1% and 100% in Perceval-S and Intuity group, respectively (P = 1.000). Thirty-day Valve Academic Research Consortium mortality occurred in 2 (1.7%) and 4 (3.4%) patients in the Perceval-S and in Intuity group, respectively (P = .6834). The rate of postoperative new permanent pacemaker implantation was 6% (7 patients) and 6.8% (8 patients) in the Perceval-S and in Intuity group, respectively (P = .7896). Perceval-S valve implantation requires significantly shorter aortic crossclamp and cardiopulmonary bypass times than Intuity valve implantation (aortic crossclamp time for isolated, 52 ± 14 minutes vs 62 ± 24 minutes; P < .0001). Peak transaortic gradients were 22.4 ± 8.1 mm Hg and 19.6 ± 6.7 mm Hg (P = .0144), whereas mean gradients were 11.8 ± 4.7 mm Hg and 10.5 ± 3.9 mm Hg (P = .0388) in the Perceval-S and Intuity groups, respectively. Sutureless Perceval-S and rapid-deployment Intuity bioprostheses provide good and similar early clinical and hemodynamic outcomes. Perceval-S valve implantation requires shorter crossclamp and cardiopulmonary bypass times, whereas Intuity valve implantation provides lower transaortic peak and mean gradients. The main findings of this study are that the Perceval-S (Livanova, London, United Kingdom) and Intuity (Edwards Lifesciences, Irvine, Calif) bioprostheses provide similar outcomes in terms of major early clinical end points, including pacemaker implantation rate. The Perceval-S valve requires shorter surgical times, whereas the Intuity valve provides lower postoperative aortic gradients. [Display omitted]