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Sutureless aortic valve replacement in high risk patients neutralizes expected worse hospital outcome: A clinical and economic analysis

Emmanuel Villa, Margherita Dalla Tomba, Antonio Messina, Andrea Trenta, Federico Brunelli, Marco Cirillo, Zean Mhagna, Giovanni Alfonso Chiariello, Giovanni Troise
DOI: 10.5603/CJ.a2018.0098
·
Pubmed: 30234906

open access

Ahead of print
Original articles
Published online: 2018-08-31

Abstract

Background: Aortic valve replacement (AVR) by sutureless prostheses is changing surgeon options, although which patients benefit most, as well as their possible economic impact is still to be defined.

Methods: Perceval-S prosthesis (LivaNova) is reserved, at the documented Institution, for patients at perceived high surgical risk. This retrospective analysis of outcome and resource consumption compared Perceval with other tissue valves. To clarify the comparison, only patients respecting ‘instructions-for-use’ of Perceval were reviewed. Inclusion criteria: > 65 years, +/– coronary artery bypass grafting, PFO closure or myectomy. Exclusion criteria: bicuspid, combined valve or aortic surgery. Costs were calculated per patient on a daily basis including preoperative tests, operating costs (hourly basis), disposables, drugs, blood components and personnel.

Results: The sutureless group (SU-AVR) had a higher risk profile than the sutured group (ST-AVR). Cardiopulmonary bypass (CPB) and cross-clamp times were significantly shorter in SU-AVR (isolated AVR: cross-clamp 52.9 ± 12.6 vs. 69 ± 15.3 min, p < 0.001; CPB 79.4 ± 20.3 vs. 92.7 ± 18.2 min, p < 0.001). Hospital mortality was 0.9% in SU-AVR and nil in ST-AVR, p = 0.489; intubation 7 (IQR 5-10.7) and 7 h (IQR 5–9), p = 0.785; intensive care unit 1 (IQR 1–1) and 1 day (IQR 1–1), p = 0.258; ward stay 5.5 (IQR 4–7) and 5 days (IQR 4–6), p = 0.002; pacemaker 5.7% (6/106) and 0.9% (1/109), p = 0.063, respectively. Hospital costs (excluding the prosthesis) were $12,825 (IQR 11,733–15,334) for SU-AVR and $12,386 (IQR 11,217–14,230) in ST-AVR, p = 0.055.

Conclusions: Despite higher operative risks in SU-AVR, hospital mortality, morbidity and resource consumption did not differ. Operative times were shorter with the sutureless device and this improvement, along with more frequent ministernotomy, may have improved many postoperative aims.

Abstract

Background: Aortic valve replacement (AVR) by sutureless prostheses is changing surgeon options, although which patients benefit most, as well as their possible economic impact is still to be defined.

Methods: Perceval-S prosthesis (LivaNova) is reserved, at the documented Institution, for patients at perceived high surgical risk. This retrospective analysis of outcome and resource consumption compared Perceval with other tissue valves. To clarify the comparison, only patients respecting ‘instructions-for-use’ of Perceval were reviewed. Inclusion criteria: > 65 years, +/– coronary artery bypass grafting, PFO closure or myectomy. Exclusion criteria: bicuspid, combined valve or aortic surgery. Costs were calculated per patient on a daily basis including preoperative tests, operating costs (hourly basis), disposables, drugs, blood components and personnel.

Results: The sutureless group (SU-AVR) had a higher risk profile than the sutured group (ST-AVR). Cardiopulmonary bypass (CPB) and cross-clamp times were significantly shorter in SU-AVR (isolated AVR: cross-clamp 52.9 ± 12.6 vs. 69 ± 15.3 min, p < 0.001; CPB 79.4 ± 20.3 vs. 92.7 ± 18.2 min, p < 0.001). Hospital mortality was 0.9% in SU-AVR and nil in ST-AVR, p = 0.489; intubation 7 (IQR 5-10.7) and 7 h (IQR 5–9), p = 0.785; intensive care unit 1 (IQR 1–1) and 1 day (IQR 1–1), p = 0.258; ward stay 5.5 (IQR 4–7) and 5 days (IQR 4–6), p = 0.002; pacemaker 5.7% (6/106) and 0.9% (1/109), p = 0.063, respectively. Hospital costs (excluding the prosthesis) were $12,825 (IQR 11,733–15,334) for SU-AVR and $12,386 (IQR 11,217–14,230) in ST-AVR, p = 0.055.

Conclusions: Despite higher operative risks in SU-AVR, hospital mortality, morbidity and resource consumption did not differ. Operative times were shorter with the sutureless device and this improvement, along with more frequent ministernotomy, may have improved many postoperative aims.

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Keywords

sutureless, perceval, aortic valve

About this article
Title

Sutureless aortic valve replacement in high risk patients neutralizes expected worse hospital outcome: A clinical and economic analysis

Journal

Cardiology Journal

Issue

Ahead of print

Published online

2018-08-31

DOI

10.5603/CJ.a2018.0098

Pubmed

30234906

Keywords

sutureless
perceval
aortic valve

Authors

Emmanuel Villa
Margherita Dalla Tomba
Antonio Messina
Andrea Trenta
Federico Brunelli
Marco Cirillo
Zean Mhagna
Giovanni Alfonso Chiariello
Giovanni Troise

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