Mashhour Ahmed, Zhigalov Konstantin, Mkalaluh Sabreen, Szczechowicz Marcin, Easo Jerry, Eichstaedt Harald C, Weymann Alexander
Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
Thorac Cardiovasc Surg. 2020 Oct;68(7):602-607. doi: 10.1055/s-0039-1685512. Epub 2019 Apr 19.
In our institution, we developed a modification of the standard implantation technique of the Perceval sutureless aortic prosthesis (LivaNova, London, United Kingdom) that involves the usage of snuggers for the guiding sutures during valve deployment. The technique has been described elsewhere. In this article, we present the results of our initial case series comprising 128 consecutive patients.
From September 2016 to June 2018, 128 patients received a sutureless Perceval prosthesis (mean age 72.2 ± 8.5 years, 66 males). The data of the patients were prospectively collected in our general database and retrospectively analyzed using the SPSS software version 25 (IBM SPSS Inc., Chicago, Illinois, United States). Primary end points were primary implantation success and 30-day mortality. All patients underwent transthoracic echocardiography on discharge.
Our cohort consisted of real-world scenario patients with infective endocarditis, bicuspid aortic valves and one patient with left ventricular assist device. However, we had 100% primary implantation success with no need for valve explantation or paravalvular leaks. All-cause 30-day mortality was 2.3% (3 patients) with no cardiac deaths. Two patients (1.6%) had a permanent neurological deficit, three patients (2.3%) had new-onset renal dialysis, and four patients (3.1%) needed a permanent pacemaker postoperatively.
To our knowledge, this is the first case series to report on a modified implantation technique of the Perceval prosthesis. The Perceval valve prosthesis produces excellent outcome in most pathologies, so that current contraindications should be revised.
在我们机构，我们对Perceval无缝合主动脉瓣膜假体（LivaNova，英国伦敦）的标准植入技术进行了改良，即在瓣膜植入过程中使用收紧器来引导缝线。该技术已在其他地方进行过描述。在本文中，我们展示了我们最初连续128例患者的病例系列结果。
2016年9月至2018年6月，128例患者接受了无缝合Perceval瓣膜假体（平均年龄72.2±8.5岁，男性66例）。患者数据前瞻性收集于我们的综合数据库，并使用SPSS 25软件版本（美国伊利诺伊州芝加哥市IBM SPSS公司）进行回顾性分析。主要终点是初次植入成功和30天死亡率。所有患者出院时均接受经胸超声心动图检查。
我们的队列包括患有感染性心内膜炎、二叶主动脉瓣的真实世界场景患者以及1例使用左心室辅助装置的患者。然而，我们的初次植入成功率为100%，无需瓣膜取出或瓣周漏。全因30天死亡率为2.3%（3例患者），无心脏死亡病例。2例患者（1.6%）出现永久性神经功能缺损，3例患者（2.3%）开始进行新的肾透析，4例患者（3.1%）术后需要永久性起搏器。
据我们所知，这是首个报道Perceval瓣膜改良植入技术的病例系列。Perceval瓣膜假体在大多数病理情况下都能产生优异的结果，因此当前的禁忌症应重新审视。
