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Title: Sutureless perceval aortic valve implantation compared with conventional mitroflow valve replacement
Authors: Casha, Aaron
Manche, Alexander
Camilleri, Liberato
Yamagata, Kentaro
Santucci, Stephanie
Gauci, Marilyn
Galea, Joseph
Keywords: Heart valves -- Surgery
Aortic valve -- Surgery
Heart -- Surgery
Heart -- Diseases -- Treatment
Issue Date: 2017
Publisher: Indian Association of Cardiovascular-Thoracic Surgeons
Citation: Casha, A. R., Manché, A., Camilleri, L., Yamagata, K., Santucci, S., Gauci, M., & Galea, J. (2017). Sutureless perceval aortic valve implantation compared with conventional mitroflow valve replacement. Indian Journal of Thoracic and Cardiovascular Surgery, 1-7.
Abstract: Background Patients at a high operative risk for conventional aortic valve replacement (AVR) may be offered sutureless valve implantation. Sutureless valves resemble conventional valves but incorporate an anchoring mechanism and features to circumvent paravalvular leaks without requiring annular sutures. Haematological and echocardiographic parameters in sutureless Perceval and conventional Mitroflow valves were compared retrospectively using risk-matched controls. Methods Perceval and Mitroflow valve patients were matched for pre-operative risk status using logistic Euroscore risk stratification. Haematological and echocardiographic data was collected retrospectively. Independent t tests and Mann-Whitney tests were used to compare variables between groups, with a binomial logistic regression model to determine independent variables. Results The use of sutureless Perceval aortic valves results in lower red cell distribution width (RDW) p = 0.001 and lower white cell (WBC) counts p = 0.034 but also resulted in a postoperative drop in platelet counts in two thirds of patients p = 0.038. A platelet level below 80 × 109/L on postoperative day 2 lengthened hospital stay in Perceval patients by 4.7 days, p = 0.050. Perceval implantation lead to lower crossclamp times p = 0.001 and bypass times p = 0.001 and reduced patient-prosthesis mismatch (p = 0.055). Conclusions Perceval stentless valves offer a promising alternative to conventional aortic valve replacement, with lower bypass and cross-clamp times, and an increase in indexed effective orifice area. The lower improved implantation time was associated with a lower post-operative RDW and WBC levels, indicating a muted systemic inflammatory response. The lower post-operative platelet counts delayed discharge but did not otherwise affect clinical outcome.
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