Minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis through upper ministernotomy or right anterior thoracotomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Peng ¹ , XIE Yi ¹ , WANG Chenhao ¹ , LIU Yu ¹ , LANG Qianlei ¹ , LI Wenfan ¹ ,  HU Jia ^1,2

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Cardiovascular Surgery, Guang’an Hospital of West China Hospital of Sichuan University, Guang’an, 638001, Sichuan, P. R. China;

Corresponding author：

HU Jia, Email: humanjia@msn.com

Keywords：

Minimally invasive aortic valve replacement; upper ministernotomy; right anterior thoracotomy; sutureless aortic bioprosthesis

DOI：

10.7507/1007-4848.202301035

Video：

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Objective To evaluate the clinical effect of minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis in upper ministernotomy or right anterior thoracotomy. Methods From March to November 2022, the patients with simple aortic valve disease were enrolled in the Department of Cardiovascular Surgery of West China Hospital, Sichuan University. After preoperative evaluation, Perceval sutureless bioprosthesis was successfully used to perform aortic valve replacement through the upper ministernotomy or right anterior thoracotomy. The perioperative clinical data and ultrasonic measurement data of all patients were recorded. Results A total of 5 patients with simple aortic valve disease were included, including 3 females and 2 males, with a mean age of 71.2 years. Perceval sutureless bioprosthesis was successfully implanted in 5 patients, with a success rate of 100%. There were 3 patients receiving upper ministernotomy and 2 patients receiving right anterior thoracotomy. Two patients underwent ascending aortic plasty at the same time. The mean cardiopulmonary bypass time was 61.0 min, and aortic cross-clamping time was 32.2 min. All patients were discharged successfully without perivalvular leakage, atrioventricular block or stroke. Conclusion The implantation method of Perceval sutureless bioprosthesis is simple, which can effectively reduce the perioperative risk by shortening the overall operation time, cardiopulmonary bypass time and aortic cross-clamping time. At the same time, its clinical application has promoted the development and popularization of minimally invasive aortic valve replacement, which together with Perceval sutureless bioprosthesis effectively combinates surgical effect and minimally invasive treatment, and has a good clinical application prospect because of its reliable safety and effectiveness.

Citation： YANG Peng, XIE Yi, WANG Chenhao, LIU Yu, LANG Qianlei, LI Wenfan, HU Jia. Minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis through upper ministernotomy or right anterior thoracotomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 439-445. doi: 10.7507/1007-4848.202301035 Copy

1.	Berretta P, Andreas M, Carrel TP, et al. Minimally invasive aortic valve replacement with sutureless and rapid deployment valves: A report from an international registry (sutureless and rapid deployment international registry). Eur J Cardiothorac Surg, 2019, 56(4): 793-799.
2.	Pfeiffer S, Fischlein T, Santarpino G. Sutureless sorin perceval aortic valve implantation. Semin Thorac Cardiovasc Surg, 2017, 29(1): 1-7.
3.	Di Eusanio M, Phan K, Berretta P, et al. Sutureless and rapid-deployment aortic valve replacement international registry (SURD-IR): Early results from 3 343 patients. Eur J Cardiothorac Surg, 2018, 54(4): 768-773.
4.	Szecel D, Eurlings R, Rega F, et al. Perceval sutureless aortic valve implantation: Midterm outcomes. Ann Thorac Surg, 2021, 111(4): 1331-1337.
5.	Glauber M, Miceli A, di Bacco L. Sutureless and rapid deployment valves: Implantation technique from A to Z-the Perceval valve. Ann Cardiothorac Surg, 2020, 9(4): 330-340.
6.	Mashhour A, Zhigalov K, Szczechowicz M, et al. Snugger method: The Oldenburg modification of perceval implantation technique. World J Cardiol, 2018, 10(9): 119-122.
7.	Falk V, Baumgartner H, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg, 2017, 52(4): 616-664.
8.	Phan K, Xie A, Tsai YC, et al. Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement: A Bayesian network meta-analysis. Ann Cardiothorac Surg, 2015, 4(1): 3-14.
9.	Gilmanov D, Farneti PA, Ferrarini M, et al. Full sternotomy versus right anterior minithoracotomy for isolated aortic valve replacement in octogenarians: A propensity-matched study. Interact Cardiovasc Thorac Surg, 2015, 20(6): 732-741.
10.	Fischlein T, Folliguet T, Meuris B, et al. Sutureless versus conventional bioprostheses for aortic valve replacement in severe symptomatic aortic valve stenosis. J Thorac Cardiovasc Surg, 2021, 161(3): 920-932.
11.	Berretta P, Arzt S, Fiore A, et al. Current trends of sutureless and rapid deployment valves: An 11-year experience from the Sutureless and rapid deployment international registry. Eur J Cardiothorac Surg, 2020, 58(5): 1054-1062.
12.	Fujita B, Ensminger S, Bauer T, et al. Trends in practice and outcomes from 2011 to 2015 for surgical aortic valve replacement: An update from the German aortic valve registry on 42 776 patients. Eur J Cardiothorac Surg, 2018, 53(3): 552-559.
13.	Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
14.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
15.	Muntané-Carol G, Urena M, Munoz-Garcia A, et al. Late cerebrovascular events following transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2020, 13(7): 872-881.
16.	Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
17.	Chung YH, Lee SH, Ko YG, et al. Transcatheter aortic valve replacement versus sutureless aortic valve replacement: A single center retrospective cohort study. Yonsei Med J, 2021, 62(10): 885-894.
18.	Okuno T, Tomii D, Heg D, et al. Five-year outcomes of mild paravalvular regurgitation after transcatheter aortic valve implantation. EuroIntervention, 2022, 18(1): 33-42.
19.	Meco M, Miceli A, Montisci A, et al. Sutureless aortic valve replacement versus transcatheter aortic valve implantation: A meta-analysis of comparative matched studies using propensity score matching. Interact Cardiovasc Thorac Surg, 2018, 26(2): 202-209.
20.	Muneretto C, Solinas M, Folliguet T, et al. Sutureless versus transcatheter aortic valves in elderly patients with aortic stenosis at intermediate risk: A multi-institutional study. J Thorac Cardiovasc Surg, 2022, 163(3): 925-935.
21.	Gilmanov D, Miceli A, Ferrarini M, et al. Aortic valve replacement through right anterior minithoracotomy: Can sutureless technology improve clinical outcomes? Ann Thorac Surg, 2014, 98(5): 1585-1592.
22.	Glauber M, Di Bacco L, Cuenca J, et al. Minimally invasive aortic valve replacement with sutureless valves: Results from an international prospective registry. Innovations (Phila), 2020, 15(2): 120-130.

1. Berretta P, Andreas M, Carrel TP, et al. Minimally invasive aortic valve replacement with sutureless and rapid deployment valves: A report from an international registry (sutureless and rapid deployment international registry). Eur J Cardiothorac Surg, 2019, 56(4): 793-799.
2. Pfeiffer S, Fischlein T, Santarpino G. Sutureless sorin perceval aortic valve implantation. Semin Thorac Cardiovasc Surg, 2017, 29(1): 1-7.
3. Di Eusanio M, Phan K, Berretta P, et al. Sutureless and rapid-deployment aortic valve replacement international registry (SURD-IR): Early results from 3 343 patients. Eur J Cardiothorac Surg, 2018, 54(4): 768-773.
4. Szecel D, Eurlings R, Rega F, et al. Perceval sutureless aortic valve implantation: Midterm outcomes. Ann Thorac Surg, 2021, 111(4): 1331-1337.
5. Glauber M, Miceli A, di Bacco L. Sutureless and rapid deployment valves: Implantation technique from A to Z-the Perceval valve. Ann Cardiothorac Surg, 2020, 9(4): 330-340.
6. Mashhour A, Zhigalov K, Szczechowicz M, et al. Snugger method: The Oldenburg modification of perceval implantation technique. World J Cardiol, 2018, 10(9): 119-122.
7. Falk V, Baumgartner H, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg, 2017, 52(4): 616-664.
8. Phan K, Xie A, Tsai YC, et al. Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement: A Bayesian network meta-analysis. Ann Cardiothorac Surg, 2015, 4(1): 3-14.
9. Gilmanov D, Farneti PA, Ferrarini M, et al. Full sternotomy versus right anterior minithoracotomy for isolated aortic valve replacement in octogenarians: A propensity-matched study. Interact Cardiovasc Thorac Surg, 2015, 20(6): 732-741.
10. Fischlein T, Folliguet T, Meuris B, et al. Sutureless versus conventional bioprostheses for aortic valve replacement in severe symptomatic aortic valve stenosis. J Thorac Cardiovasc Surg, 2021, 161(3): 920-932.
11. Berretta P, Arzt S, Fiore A, et al. Current trends of sutureless and rapid deployment valves: An 11-year experience from the Sutureless and rapid deployment international registry. Eur J Cardiothorac Surg, 2020, 58(5): 1054-1062.
12. Fujita B, Ensminger S, Bauer T, et al. Trends in practice and outcomes from 2011 to 2015 for surgical aortic valve replacement: An update from the German aortic valve registry on 42 776 patients. Eur J Cardiothorac Surg, 2018, 53(3): 552-559.
13. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
14. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
15. Muntané-Carol G, Urena M, Munoz-Garcia A, et al. Late cerebrovascular events following transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2020, 13(7): 872-881.
16. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
17. Chung YH, Lee SH, Ko YG, et al. Transcatheter aortic valve replacement versus sutureless aortic valve replacement: A single center retrospective cohort study. Yonsei Med J, 2021, 62(10): 885-894.
18. Okuno T, Tomii D, Heg D, et al. Five-year outcomes of mild paravalvular regurgitation after transcatheter aortic valve implantation. EuroIntervention, 2022, 18(1): 33-42.
19. Meco M, Miceli A, Montisci A, et al. Sutureless aortic valve replacement versus transcatheter aortic valve implantation: A meta-analysis of comparative matched studies using propensity score matching. Interact Cardiovasc Thorac Surg, 2018, 26(2): 202-209.
20. Muneretto C, Solinas M, Folliguet T, et al. Sutureless versus transcatheter aortic valves in elderly patients with aortic stenosis at intermediate risk: A multi-institutional study. J Thorac Cardiovasc Surg, 2022, 163(3): 925-935.
21. Gilmanov D, Miceli A, Ferrarini M, et al. Aortic valve replacement through right anterior minithoracotomy: Can sutureless technology improve clinical outcomes? Ann Thorac Surg, 2014, 98(5): 1585-1592.
22. Glauber M, Di Bacco L, Cuenca J, et al. Minimally invasive aortic valve replacement with sutureless valves: Results from an international prospective registry. Innovations (Phila), 2020, 15(2): 120-130.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis through upper ministernotomy or right anterior thoracotomy

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