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      Sutureless Biological Aortic Valve Replacement (Su-AVR) in Redo operations: a retrospective real-world experience report of clinical and echocardiographic outcomes

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          Abstract

          Objective

          This retrospective study aimed to compare the outcomes of sutureless aortic valve replacement (su-AVR) and conventional bioprosthetic sutured AVR (cAVR) in high-risk patients undergoing redo surgery.

          Methods

          A total of 79 patients who underwent redo AVR between 2014 and 2021 were included in the study. Of these, 27 patients underwent su-AVR and 52 underwent cAVR. Patient characteristics and clinical outcomes were analysed using multivariate regression and Kaplan Meier survival test.

          Results

          The groups were similar in terms of age, gender, left ventricular function, and number of previous sternotomies. In cases of isolated AVR, su-AVR had significantly lower cross clamp times than cAVR (71 vs. 86 min, p = 0.03). Postoperatively, 4 cAVR patients required pacemaker compared to zero patients in the su-AVR group. There were no significant differences between the two groups in terms of postoperative complications, intrahospital stay (median 9 days, IQR 7–20), or in-hospital mortality (1 su-AVR; 2 cAVR). The long-term survival rate was similar between the su-AVR (90%) and cAVR (92%) groups (log rank p = 0.8). The transvalvular gradients at follow-up were not affected by the type of valve used, regardless of the valve size (coef 2.68, 95%CI -3.14–8.50, p = 0.36).

          Conclusion

          The study suggests that su-AVR is a feasible and safe alternative to cAVR in high-risk patients undergoing redo surgery. The use of su-AVR offers comparable outcomes to cAVR, with reduced cross clamp times and a lower incidence of postoperative pacemaker requirement in isolated AVR cases. The results of this study contribute to the growing body of evidence supporting the use of su-AVR in high-risk patients, highlighting its feasibility and safety in redo surgeries.

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          Most cited references16

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          Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery.

          S Salis, Fabrizio Veglia, Antonio C Tedesco … (2008)
          The aim of this study was to determine if there is a direct relationship between the duration of cardiopulmonary bypass (CPB time [CPBT]) and postoperative morbidity and mortality in patients undergoing cardiac surgery. Retrospective study. Cardiac surgery unit, university hospital. Five thousand six patients, New York Heart Association classes 1 through 4, who underwent cardiac surgery between January 2002 and March 2008. All patients were subjected to CPB. The mean CPBT was 115 minutes (median 106). One hundred thirty-one patients (2.6%) died during the same hospitalization. The postoperative median blood loss was 600 mL. Reoperations for bleeding occurred in 193 patients (3.9%), and 1,001 patients received 3 or more units of red blood cells. There were 108 patients (2.2%) with neurologic sequelae, 391 patients (7.8%) with renal complications, 37 patients (0.7%) with abdominal complications, and 184 patients (3.7%) with respiratory complications. Seventy-two patients (1.4%) had an infective complication, and 80 patients (1.6%) had a postoperative multiorgan failure. The multivariate analysis confirmed the role of CPBT, considered in 30-minute increments, as an independent risk factor for postoperative death (odds ratio [OR] = 1.57, p < 0.0001), pulmonary (OR = 1.17, p < 0.0001), renal (OR 1.31, p < 0.0001), and neurologic complications (OR = 1.28, p < 0.0001), multiorgan failure (OR = 1.21, p < 0.0001), reoperation for bleeding (OR = 1.1, p = 0.0165), and multiple blood transfusions (OR = 1.58, p < 0.0001). Prolonged CPB duration independently predicts postoperative morbidity and mortality after cardiac surgery.
          Article 0 comments Cited 95 times – based on 0 reviews     Review now
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            Cross-clamp time is an independent predictor of mortality and morbidity in low- and high-risk cardiac patients.

            Hsu-Wen Young, Michael Tolan, Ieuan A. Hughes … (2010)
            We sought to assess the effects of aortic cross-clamp time (XCL) on outcome following cardiac surgery in low- and high-risk patients. This is a retrospective review of prospectively collected departmental data of all patients who underwent cardiac surgery over 8-year period. Our cohort consisted of 3799 consecutive patients subdivided into low-risk (Euro SCORE   60 but ≤ 90 min) and group 3 (XCL >90 min). Postoperative morbidity and in-hospital mortality were analysed. Univariate analysis showed the following to be significantly associated with increased XCL time in both low- and high-risk patients: low cardiac output, prolonged ventilation time, renal complications, prolonged hospital stay, blood transfusion and increased mortality (p  60 min was independent risk factor for low cardiac output, prolonged ventilation, renal complication, blood transfusion, mortality and prolonged hospital stay in both groups. By using XCL time as a continuous variable, an incremental increase of 1 min interval in XCL time was associated with a 2% increase in mortality in both groups. Prolonged cross-clamp time significantly correlates with major post-operative morbidity and mortality in both low- and high-risk patients. This effect increases with increasing XCL time. Prior knowledge on this effect can help in preventing some of these complications. Copyright © 2010 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
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              Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement

              Natalie Glaser, Veronica Jackson, Martin Holzmann … (2017)
              Article 0 comments Cited 27 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                M Yousuf Salmasi: y.salmasi@imperial.ac.uk
                Journal
                Journal ID (nlm-ta): BMC Cardiovasc Disord
                Journal ID (iso-abbrev): BMC Cardiovasc Disord
                Title: BMC Cardiovascular Disorders
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2261
                Publication date (Electronic): 3 January 2024
                Publication date PMC-release: 3 January 2024
                Publication date Collection: 2024
                Volume: 24
                Electronic Location Identifier: 28
                Affiliations
                [1 ]Department of Cardiac Surgery, St Thomas Hospital, ( https://ror.org/054gk2851) London, UK
                [2 ]Department of Surgery, Imperial College London, QEQM Building, ( https://ror.org/041kmwe10) South Wharf Road, London, UK
                [3 ]Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, ( https://ror.org/02218z997) London, UK
                Article
                Publisher ID: 3652
                DOI: 10.1186/s12872-023-03652-7
                PMC ID: 10765636
                PubMed ID: 38172707
                SO-VID: 74811b80-3128-4648-b372-a5ffce8029c2
                Copyright © © The Author(s) 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 19 August 2023
                Date accepted : 3 December 2023
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2024

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: perceval,sutureless,aortic valve replacement,redo cardiac surgery
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: perceval, sutureless, aortic valve replacement, redo cardiac surgery

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