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MINERVA CARDIOANGIOLOGICA

A Journal on Heart and Vascular Diseases


Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2017 Dec 14

DOI: 10.23736/S0026-4725.17.04590-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Sutureless valves and the quality of perfusion: towards a goal directed aortic valve replacement

Antonino S. RUBINO , Carmelo MIGNOSA

Department of Cardiology and Cardiovascular Surgery, C.C.D. G.B. Morgagni, Heart Center, Pedara, Catania, Italy


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BACKGROUND: Aim of this study was to assess the potential differences in respecting the principles of goal-directed perfusion between aortic valve replacement with sutureless vs conventional stented bioprostheses.
METHODS: Data from 94 consecutive patients undergoing aortic valve replacement with Perceval sutureless valve, with or without concomitant CABG, were compared to a contemporary cohort of 116 patients receiving conventional stented bioprostheses. Propensity score matching was used to reduce selection bias. Flow-dependent estimate of oxygen delivery and carbon dioxide production were compared in accordance to the principles of goal directed perfusion. Hospital outcomes were assessed as well.
RESULTS: Propensity score matching resulted in 39 pairs with similar characteristics and operative risk. Cross-clamping time (41.6±20.6 vs 89.6±48.2; p<0.001) and cardiopulmonary bypass time (66.9±29.4 vs 121.2±56.6, p<0.001) were shorter in Perceval patients. Flow-dependent parameters were significantly better in Perceval patients (peak VCO2i p=0.010; nadir VO2i p=0.035; nadir DO2i/VCO2i p=0.015; peak RQ p=0.020) and therefore goal-directed perfusion principles were met more frequently (all p<0.001). Peak lactates were higher in Controls (p=0.001), as well as number of patients receiving transfusions during CPB (p=0.044). QualyP Score was also higher in Controls (p<0.001). Perceval patients experienced reduced postoperative bleeding, had a lower incidence of surgical revisions and transfusions. Duration of ventilation was longer in Controls.
CONCLUSIONS: The use of sutureless valves significantly reduces cardiopulmonary bypass and cross-clamping times and contributes to achieve a goal-directed perfusion. This results in better perfusion quality, with a positive clinical impact.


KEY WORDS: Aortic valve replacement - Sutureless - Goal directed perfusion

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Publication History

Article first published online: December 14, 2017
Manuscript accepted: December 7, 2017
Manuscript received: December 6, 2017

Cite this article as

Rubino AS, Mignosa C. Sutureless valves and the quality of perfusion: towards a goal directed aortic valve replacement. Minerva Cardioangiol 2017 Dec 14. DOI: 10.23736/S0026-4725.17.04590-X

Corresponding author e-mail

antonio.rubino@hotmail.com