Nardi Paolo, Altieri Claudia, Pisano Calogera, Buioni Dario, Agneni Federico, Grizzi Giorgia, Dakli Martin, Salvati Alessandro Cristian, Scognamiglio Mattia, Bassano Carlo, Ruvolo Giovanni
Division of Cardiac Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy.
Cardiology Unit, Division of Cardiac Surgery, Tor Vergata University of Rome, Rome, Italy.
Kardiochir Torakochirurgia Pol. 2024 Sep;21(3):153-161. doi: 10.5114/kitp.2024.143499. Epub 2024 Sep 25.
The Perceval sutureless biological prosthesis for aortic valve replacement has been introduced with the rationale for shortening surgical, extracorporeal circulation and aortic cross-clamping times, in order to reduce postoperative complications.
To evaluate early hemodynamic performance and immediate outcomes of implantation of the Perceval sutureless bioprosthesis in comparison with the St. Jude Trifecta sutured bioprosthesis for aortic valve replacement (Perfecta study).
Between December 2014 and June 2023, 281 patients underwent St. Jude Trifecta implantation ( = 220, mean age: 75.2 ±6.5 years) and Perceval implantation, when indicated ( = 61, mean age: 77.9 ±5.1 years). Concomitant CABG was performed in 73 (33%) and in 27 (44%) patients, respectively.
Extracorporeal circulation and cross-clamp times were significantly shorter in Perceval patients in all aortic valve replacements (61 ±23 and 49 ±18 minutes vs. 96 ±36 and 67 ±21 minutes), and in isolated procedures (54 ±10 and 43 ±8 minutes vs. 84 ±28 and 66 ±21 minutes) ( < 0.0001, for all comparisons). Operative mortality was absent and 2.7%, respectively ( = 0.2). Postoperatively, low output cardiac syndrome (0% vs. 4.5%) and total rate of major cardiac and non-cardiac related complications (6.6% vs. 18.6%) were significantly lower in Perceval patients ( = 0.01). Echocardiography at discharge in comparison with preoperatively showed a relevant and similar decrease of mean and peak trans-aortic valve gradients for the Trifecta prosthesis (11.6 ±4.3 vs. 50 ±15.2 mm Hg; 21.6 ±7.3 vs. 78.8 ±24 mm Hg) and for the Perceval prosthesis (12.6 ±4.8 vs. 52 ±12.5 mm Hg; 22.6 ±7.9 vs. 77.8 ±16 mm Hg) ( < 0.00001, for all comparisons). Better global cardiac function was observed in Perceval patients. Concomitant multi-vessel and left main coronary artery disease ( = 0.046; HR = 4.6) and chronic pulmonary disease ( = 0.006; HR = 5.6) were detected as independent predictors of death and postoperative major complications.
Early hemodynamic performance appears to be satisfactory with the use of Trifecta sutured and Perceval sutureless bioprostheses. Perceval implantation allows reduction of surgical times, better preservation of myocardial contractile function and, consequently, reduction of the risk of postoperative complications.
用于主动脉瓣置换的Perceval无缝合生物假体已被引入，其理论依据是缩短手术、体外循环和主动脉阻断时间，以减少术后并发症。
与圣犹达Trifecta缝合生物假体用于主动脉瓣置换相比，评估Perceval无缝合生物假体植入的早期血流动力学性能和即刻结果（Perfecta研究）。
2014年12月至2023年6月期间，281例患者接受了圣犹达Trifecta植入（n = 220，平均年龄：75.2±6.5岁），并在有指征时接受了Perceval植入（n = 61，平均年龄：77.9±5.1岁）。分别有73例（33%）和27例（44%）患者同时进行了冠状动脉旁路移植术（CABG）。
在所有主动脉瓣置换术中，Perceval组患者的体外循环和阻断时间显著缩短（61±23分钟和49±18分钟，对比96±36分钟和67±21分钟），在单纯手术中也是如此（54±10分钟和43±8分钟，对比84±28分钟和66±21分钟）（所有比较，P < 0.0001）。手术死亡率分别为0%和2.7%（P = 0.2）。术后，Perceval组患者的低心排综合征（0%对比4.5%）以及主要心脏和非心脏相关并发症的总发生率（6.6%对比18.6%）显著更低（P = 0.01）。与术前相比，出院时超声心动图显示Trifecta假体的平均和跨主动脉瓣峰值梯度有显著且相似的下降（11.6±4.3对比50±15.2 mmHg；21.6±7.3对比78.8±24 mmHg），Perceval假体也是如此（12.6±4.8对比52±12.5 mmHg；22.6±7.9对比77.8±16 mmHg）（所有比较，P < 0.00001）。Perceval组患者观察到更好的整体心脏功能。合并多支血管和左主干冠状动脉疾病（P = 0.046；HR = 4.6）以及慢性肺部疾病（P = 0.006；HR = 5.6）被检测为死亡和术后主要并发症的独立预测因素。
使用Trifecta缝合生物假体和Perceval无缝合生物假体时，早期血流动力学性能似乎令人满意。Perceval植入可减少手术时间，更好地保留心肌收缩功能，从而降低术后并发症风险。
