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Is sub-commissural annuloplasty a safe adjunct to sutureless Perceval-S aortic valve implantation ?
  • +3
  • Aurélien Roumy,
  • Mario Verdugo,
  • ziyad Gunga,
  • Pierre Monney,
  • Valentina Rancati,
  • Matthias Kirsch
Aurélien Roumy
CHUV
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Mario Verdugo
CHUV
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ziyad Gunga
CHUV
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Pierre Monney
CHUV
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Valentina Rancati
CHUV
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Matthias Kirsch
CHUV
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Peer review status:IN REVISION

01 Jun 2020Submitted to Journal of Cardiac Surgery
04 Jun 2020Assigned to Editor
04 Jun 2020Submission Checks Completed
05 Jun 2020Reviewer(s) Assigned
07 Jun 2020Review(s) Completed, Editorial Evaluation Pending
08 Jun 2020Editorial Decision: Revise Major

Abstract

Background: Sutureless bioprothesis aortic valves simplify surgery for aortic valve replacement (AVR) but some anatomical features of the recipients aortic annulus might preclude anchoring and lead to paravalvular leak. Sub-commissural annuloplasty (SCAP) has been sporadically proposed to secure implantation under these circumstances. This study evaluated whether SCAP affects early postoperative outcomes after sutureless Perceval-S implantation. Methods: We included all patients who underwent AVR (isolated or combined with coronary bypass) with the Perceval-S valve from March 2016 to August 2019. SCAP was performed each time the surgeon deemed it useful to improve anchoring, including after primary implantation failure. Results: One hundred and three patients were included. Mean age was 73.9±7.2 years and 36(35%) were women. SCAP was performed in 34(33%) patients, significantly more frequently in patients with large aortic annulus or bicuspid aortic valve. Perceval-S implantation was successful in 100(97%) patients and SCAP allowed successful redeployment of the same Perceval S valve in 4(28%) of first implantation failures. Thirty-day mortality was 2% (n=2), of which one was related to the procedure. There was no significant difference in the incidence of postoperative conduction disorders between patients with and without SCAP (respectively, 3[9%] vs 7[10%], p=1.0). More than trivial paravalvular leak was noted in 1(1%) patient without SCAP. Postoperative peak and mean pressure gradients were lower in patients with than in those without SCAP (respectively, 19.0±7.9 mmHg vs 23.1±7.0 mmHg, p=0.001; and 10.4±4.1 versus 12.6±3.7 mmHg, p=0.001). Conclusions: SCAP is a safe, simple and reproducible technique that might facilitate Perceval-S aortic valve implantation.