Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
Administrative Department, Poliambulanza Foundation Hospital, Brescia, Italy.
Cardiol J. 2019;26(1):56-65. doi: 10.5603/CJ.a2018.0098. Epub 2018 Sep 20.
Aortic valve replacement (AVR) by sutureless prostheses is changing surgeon options, although which patients benefit most, as well as their possible economic impact is still to be defined.
Perceval-S prosthesis (LivaNova) is reserved, at the documented Institution, for patients at perceived high surgical risk. This retrospective analysis of outcome and resource consumption compared Perceval with other tissue valves. To clarify the comparison, only patients respecting 'instructions-for- use' of Perceval were reviewed.
65 years, +/- coronary artery bypass grafting, patent foramen ovale closure or myectomy.
bicuspid, combined valve or aortic sur- gery. Costs were calculated per patient on a daily basis including preoperative tests, operating costs (hourly basis), disposables, drugs, blood components and personnel.
The sutureless group (SU-AVR) had a higher risk profile than the sutured group (ST-AVR). Cardiopulmonary bypass (CPB) and cross-clamp times were significantly shorter in SU-AVR (isolated AVR: cross-clamp 52.9 ± 12.6 vs. 69 ± 15.3 min, p < 0.001; CPB 79.4 ± 20.3 vs. 92.7 ± 18.2 min, p < 0.001). Hospital mortality was 0.9% in SU-AVR and nil in ST-AVR, p = 0.489; intubation 7 (IQR 5-10.7) and 7 h (IQR 5-9), p = 0.785; intensive care unit 1 (IQR 1-1) and 1 day (IQR 1-1), p = 0.258; ward stay 5.5 (IQR 4-7) and 5 days (IQR 4-6), p = 0.002; pacemaker 5.7% (6/106) and 0.9% (1/109), p = 0.063, respectively. Hospital costs (excluding the prosthesis) were $12,825 (IQR 11,733-15,334) for SU-AVR and $12,386 (IQR 11,217-14,230) in ST-AVR, p = 0.055.
Despite higher operative risks in SU-AVR, hospital mortality, morbidity and resource consumption did not differ. Operative times were shorter with the sutureless device and this improve- ment, along with more frequent ministernotomy, may have improved many postoperative aims.
无缝线假体主动脉瓣置换术（AVR）正在改变外科医生的选择，尽管哪些患者受益最大，以及它们可能的经济影响仍有待确定。
在记录机构中，Perceval-S 假体（LivaNova）仅用于手术风险高的患者。本回顾性分析比较了 Perceval 与其他组织瓣膜的结果和资源消耗。为了澄清比较，仅审查了符合 Perceval“使用说明”的患者。
65 岁，+/-冠状动脉旁路移植术、卵圆孔未闭关闭或心肌切除术。
二叶式、联合瓣膜或主动脉手术。每位患者的费用按每日计算，包括术前检查、手术费用（按小时计算）、一次性用品、药物、血液成分和人员。
无缝线组（SU-AVR）的风险状况高于缝线组（ST-AVR）。SU-AVR 的体外循环（CPB）和体外循环时间明显缩短（单纯 AVR：体外循环 52.9±12.6 分钟与 69±15.3 分钟，p<0.001；CPB 79.4±20.3 分钟与 92.7±18.2 分钟，p<0.001）。SU-AVR 组的院内死亡率为 0.9%，ST-AVR 组为 0%，p=0.489；插管 7（IQR 5-10.7）和 7 小时（IQR 5-9），p=0.785；重症监护病房 1（IQR 1-1）和 1 天（IQR 1-1），p=0.258；病房住院时间 5.5（IQR 4-7）和 5 天（IQR 4-6），p=0.002；起搏器 5.7%（6/106）和 0.9%（1/109），p=0.063。SU-AVR 的医院费用（不包括假体）为 12825 美元（IQR 11733-15334），ST-AVR 为 12386 美元（IQR 11217-14230），p=0.055。
尽管 SU-AVR 手术风险较高，但院内死亡率、发病率和资源消耗并无差异。无缝线装置的手术时间更短，这种改进以及更频繁的小开胸术可能改善了许多术后目标。
