Aljalloud Ali, Moza Ajay, Arias Jessica Paola, Menne Matthias, Becker Michael, Spetsotaki Konstantina
Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany.
Department of Cardiology, Rhein Maas Klinikum, 52146 Würselen, Germany.
J Cardiovasc Dev Dis. 2023 Jul 20;10(7):311. doi: 10.3390/jcdd10070311.
: The benefits of sutureless compared to conventional aortic valve prosthesis replacement remain controversial. Supposed advantages of sutureless aortic valve replacement include shortened cross-clamp and implantation time, as well as improved overall safety and good post-operative performance. We aimed to compare the early outcomes and performance of sutureless aortic valve replacement (su-AVR) with the sutureless Perceval (Corcym, Milan, Italy) vs. the conventional AVR with a conventional counterpart, in this case, the Labcor Dokimos Plus (LDP) aortic bioprosthesis. : We compared two types of aortic valve prostheses, the sutureless (Corcym, Milan, Italy) and the conventional valve Labcor Dokimos Plus (LDP), implanted between August 2014 and May 2019 in our Department of Cardiac Surgery at RWTH Aachen University Hospital. Data were collected from 141 patients who received the Perceval (Corcym, Milan, Italy) and 138 who received the Labcor Dokimos Plus (LDP) aortic bioprosthesis. After matching the two groups considering STS mortality risk and pre-operative LDH levels, 201 patients were included in our final study cohort. Seventy-one patients (17 from the Perceval group and 54 from the Dokimos group) were excluded due to the lack of complete data, particularly standardized echocardiographic data ( = 71). Primary endpoints were 30-day mortality, length of hospital stay, and pacemaker implantation. Secondary endpoints were echocardiographic parameters, major adverse cardiovascular events, and prosthesis failure (grade II aortic regurgitation, paravalvular leak with reintervention). : Bypass and cross-clamp time proved to be shorter in the Perceval group, while hospital stays were longer. The faster implantation had no effect on the 30-day mortality primary endpoint. Transvalvular gradients were significantly higher in the Perceval group, in addition to a smaller effective orifice area. The LDH values were remarkably higher post-operatively in the Perceval group. : Regarding the clinical outcomes, Perceval was equivalent and not superior to the Dokimus bioprosthesis. The suitability of a Perceval prosthesis implantation must be determined on a case-by-case basis and reserved for elderly patients with increased comorbidity.
与传统主动脉瓣置换术相比，无缝合主动脉瓣置换术的优势仍存在争议。无缝合主动脉瓣置换术的假定优势包括缩短主动脉阻断和植入时间，以及提高整体安全性和术后良好表现。我们旨在比较无缝合Perceval（意大利米兰Corcym公司）主动脉瓣置换术（su-AVR）与传统主动脉瓣置换术（使用传统的Labcor Dokimos Plus（LDP）主动脉生物假体）的早期结果和性能。
我们比较了2014年8月至2019年5月在亚琛工业大学医院心脏外科植入的两种主动脉瓣假体，即无缝合的（意大利米兰Corcym公司）和传统的Labcor Dokimos Plus（LDP）瓣膜。收集了141例接受Perceval（意大利米兰Corcym公司）的患者和138例接受Labcor Dokimos Plus（LDP）主动脉生物假体患者的数据。在根据胸外科医师协会（STS）死亡风险和术前乳酸脱氢酶（LDH）水平匹配两组后，201例患者被纳入我们的最终研究队列。71例患者（17例来自Perceval组，54例来自Dokimos组）因缺乏完整数据，特别是标准化超声心动图数据而被排除（n = 71）。主要终点为30天死亡率、住院时间和起搏器植入。次要终点为超声心动图参数、主要不良心血管事件和假体失败（II级主动脉瓣反流、需要再次干预的瓣周漏）。
结果显示，Perceval组的体外循环和主动脉阻断时间较短，但住院时间较长。更快的植入速度对30天死亡率这一主要终点没有影响。Perceval组的跨瓣压差明显更高，有效瓣口面积更小。Perceval组术后的LDH值也显著更高。
关于临床结果，Perceval与Dokimos生物假体相当，并不优于后者。Perceval假体植入的适用性必须逐例确定，且应保留给合并症增加的老年患者。
