ISSN: 2233-601X (Print) ISSN: 2093-6516 (Online) − 165 − Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital Received: November 9, 2015, Revised: February 6, 2016, Accepted: February 12, 2016, Published online: June 5, 2016 Corresponding author: Muhammet Onur Hanedan, Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital, Soğuksu Mah. Vatan Cad. No. 9 Ahi Evren Hastanesi 61040 Ortahisar, Trabzon, Türkiye (Tel) 90-505-799-5155 (Fax) 90-462-231-0483 (E-mail) [email protected]C The Korean Society for Thoracic and Cardiovascular Surgery. 2016. All right reserved. CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creative- commons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Early Outcomes of Sutureless Aortic Valves Muhammet Onur Hanedan, M.D., İlker Mataracı, M.D., Mehmet Ali Yürük, M.D., Tanıl Özer, M.D., Ufuk Sayar, M.D., Ali Kemal Arslan, M.D., Uğur Ziyrek, M.D., Murat Yücel, M.D. Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alter- native to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study re- ports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time. Key words: 1. Prosthesis design 2. Heart valve prosthesis implantation 3. Bioprosthesis INTRODUCTION The increase in life expectancy among the general pop- ulation has resulted in an increase in the prevalence of pa- tients with valvular heart disease eligible for aortic valve re- placement (AVR) [1]. The most effective treatment for pa- tients with severe symptomatic aortic stenosis is surgical re- placement of the valve. Valve replacement improves left ven- tricular (LV) systolic and diastolic function by reducing LV hypertrophy, and thereby results in better clinical outcomes [2]. Given the increasing number of comorbidities and the in- creasing age of patients, a tendency has emerged to use bio- logical valve implants, avoiding the need for long-term anti- coagulation therapy [3]. In comparison with stented biopro- Korean J Thorac Cardiovasc Surg 2016;49:165-170 □ Clinical Research □ http://dx.doi.org/10.5090/kjtcs.2016.49.3.165
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ISSN: 2233-601X (Print) ISSN: 2093-6516 (Online)
− 165 −
Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research HospitalReceived: November 9, 2015, Revised: February 6, 2016, Accepted: February 12, 2016, Published online: June 5, 2016
Corresponding author: Muhammet Onur Hanedan, Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education
and Research Hospital, So uksu Mah. Vatan Cad. No. 9 Ahi Evren Hastanesi 61040 Ortahisar, Trabzon, Türkiye(Tel) 90-505-799-5155 (Fax) 90-462-231-0483 (E-mail) [email protected]
C The Korean Society for Thoracic and Cardiovascular Surgery. 2016. All right reserved.CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creative-
commons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Early Outcomes of Sutureless Aortic Valves
Muhammet Onur Hanedan, M.D., lker Matarac , M.D., Mehmet Ali Yürük, M.D., Tan l Özer, M.D., Ufuk Sayar, M.D., Ali Kemal Arslan, M.D., U ur Ziyrek, M.D., Murat Yücel, M.D.
Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alter-
native to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and
cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions,
while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study re-
ports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods:
Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic
valve disease and New York Heart Association function of class II or higher were included to this study. Perceval
S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves
were used. Results: The mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female.
The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and
the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive
care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage
from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%)
died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%.
Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The
present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results
of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable
ischemic time.
Key words: 1. Prosthesis design
2. Heart valve prosthesis implantation
3. Bioprosthesis
INTRODUCTION
The increase in life expectancy among the general pop-
ulation has resulted in an increase in the prevalence of pa-
tients with valvular heart disease eligible for aortic valve re-
placement (AVR) [1]. The most effective treatment for pa-
tients with severe symptomatic aortic stenosis is surgical re-
placement of the valve. Valve replacement improves left ven-
tricular (LV) systolic and diastolic function by reducing LV
hypertrophy, and thereby results in better clinical outcomes
[2]. Given the increasing number of comorbidities and the in-
creasing age of patients, a tendency has emerged to use bio-
logical valve implants, avoiding the need for long-term anti-
coagulation therapy [3]. In comparison with stented biopro-
Korean J Thorac Cardiovasc Surg 2016;49:165-170 □ Clinical Research □
http://dx.doi.org/10.5090/kjtcs.2016.49.3.165
Muhammet Onur Hanedan, et al
− 166 −
stheses and mechanical valves, stentless bioprostheses provide
a significant reduction in transvalvular pressure gradients.
However, they are more difficult to insert, with increased
cross-clamping time [4].
AVR with any kind of bioprosthesis is the preferred method,
especially in older patients, due to satisfactory hemodynamic
performance and postoperative durability without warfarin-re-