Redo aortic valve replacement: the sutureless approach
Transcript of Redo aortic valve replacement: the sutureless approach
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Redo aortic valve replacement:
the sutureless approach
G. Santarpino*, S. Pfeiffer, G. Concistré, T. J. FischleinKlinikum Nürnberg - Cardiovascular Center, Nuremberg, Germany
* No conflict of interest
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There are many questions with more than one answer in cardiac surgery…
Without debate, there would be no progress!
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Redos
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We are looking for new ideas to keep it simple and safe
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CAVALIER TRIAL – update at December 15, 2011
558 patients
(from Feb 2010)
83 pts. in
Nuremberg
13 pts. in Redos
(15,7%)
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Redos - Preoperative data
Pts n. 13
Age mean 75,2 ± 5,6 min 67 max 86Age mean 75,2 ± 5,6 min 67 max 86
Log Euroscore 19,4±10,7 min 8,5 max 47,5
male/female 6/7 (46/54%)
First operation: CABG in 7
AVR in 5
AVR+CABG in 1
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Intraoperative data
21 mm
1 pts (8%)
25 mm
5 pts (38%)
23 mm
7 pts (54%)
5 pts (38%)
Associated procedure 2 (15,4%) 1 Re-CABG
1 TV-annuloplasty
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Intraoperative data
Stentless Solo 23 mm > Perceval 23
Stentless Freedom 25 mm > Perceval 21
Stentless Freedom 27 mm > Perceval 23
Stentless Shelhigh 25 mm > Perceval 23
=
Stentless Shelhigh 25 mm > Perceval 23
Stented Soprano 18 mm > Perceval 23
Stented Mitroflow 21 mm > Perceval 23
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Intraoperative data
CPB 79±23 min
X-clamp 44±16 minX-clamp 44±16 min
Implant 8±2,3 min
No associated procedure and first OP CABG or first OP stentless (9 pts) 27
min DS????
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Intraoperative data
1 CABG lesion
1 intraoperative explant
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Postoperative data
No migration
No thrombosis
ICU 3,2±2,2
Hospital 12,1±4,4
No exitus
1 pacemaker (7,7%)
1 TIA (7,7%)
1 Transient renal failure (UF) (7,7%)
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Follow up 8,5 months (up to 15 months)
Freedom from reoperation and/or endocarditis 100%
no exitus
no events
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Preop (13 pts) Postop (13 pts) 6 months (11 pts) 1 year (5 pts)
max mn max mn max mn max Mn
85±19 48±13,5 26,7±9 14,3±4,9 24,9±4,4 12,7±6,5 21,7±5 12,1±4,4
90
100mmHg
Gradients
0
10
20
30
40
50
60
70
80
90
preop postop 6 months 1 year
Gr max
Gr mn
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1 1 0
0 0 0
Aortic insufficiency
Valvular regurgitation
Trivial
Mild
At discharge 6 mo 12 mo
(n=13) (n=11) (n=5)
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Mild
Moderate
Paravalvular regurgitation
Trivial
Mild
Moderate
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Is safe, fast and easy, requiring only a short learning curve
Conclusion
Ensures excellent haemodynamic performance
Allows X-clamp time reduction
Is a step forward for redo procedures
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Nuremberg - Germany
Thank you! Danke! Grazie!