Rapid Deployment Aortic Valve Replacement with the Perceval S and Intuity Elite

Oliver J. Liakopoulos; Stephen Gerfer; Parwis Rahmanian; Kaveh Eghbalzadeh; Ilija Djordjevic; Georg Schlachtenberger; Mohamed Zeriouh; Navid Mader; Yeong-Hoon Choi; Thorsten Wahlers

doi:10.1055/s-0040-1716892

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2021; 69(05): 412-419
DOI: 10.1055/s-0040-1716892

Original Cardiovascular

Rapid Deployment Aortic Valve Replacement with the Perceval S and Intuity Elite

Oliver J. Liakopoulos‡^*

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

²Department of Cardiac Surgery, Campus Kerckhoff, University of Giessen, Giessen, Germany

,

Stephen Gerfer^*

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

,

Parwis Rahmanian

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

,

Kaveh Eghbalzadeh

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

,

Ilija Djordjevic

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

,

Georg Schlachtenberger

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

,

Mohamed Zeriouh

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

²Department of Cardiac Surgery, Campus Kerckhoff, University of Giessen, Giessen, Germany

,

Navid Mader

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

,

Yeong-Hoon Choi

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

²Department of Cardiac Surgery, Campus Kerckhoff, University of Giessen, Giessen, Germany

³German Center for Cardiovascular Research (DZHK), Partner Site Rhine/Main, Frankfurt/Main, Germany

,

Thorsten Wahlers

¹Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany

› Author Affiliations

Abstract

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Abstract

Background Rapid deployment aortic valve replacement (RDAVR) has emerged as an alternative to conventional aortic valve replacement. This single-center study retrospectively analyzed clinical outcomes and hemodynamic performance of the Perceval S (LivaNova) and Intuity Elite (Edwards LifeSciences) rapid deployment valves (RDVs) in a propensity score matched patient cohort.

Methods A total of 372 consecutive patients with symptomatic aortic valve stenosis underwent RDAVR between 2012 and 2018 at our institution. The Intuity Elite (INT group) and Perceval S (PER group) were implanted in 251 and 121 patients, respectively. After 1:1 propensity score matching for relevant preoperative comorbidities, 107 patient pairs were compared with respect to relevant perioperative data including hemodynamic parameter, postoperative pacemaker implantation, and 30-day all-cause mortality.

Results Propensity score matching resulted in balanced characteristics between groups. Cardiopulmonary bypass and aortic cross-clamp time did not differ between groups, but more patients in the INT group received coronary artery bypass grafting compared with the PER group (56 vs. 42%; p = 0.055). Thirty-day mortality (4.7 vs. 2.2%) and need for permanent pacemaker implantation (7 versus 4.4%) were comparable between the INT and PER groups for isolated AVR and also for combined procedures, respectively. Cerebrovascular events showed comparable low rates for both RDVs (INT group [1.9%] vs. PER group [2.8%]). Indexed effective orifice area was higher in the INT group (0.90 vs. 0.82 cm²/m²) and coupled to a lower peak (17 ± 7 vs. 22 ± 8) and mean (10 ± 5 vs. 12 ± 4) pressure gradients compared with the PER group.

Conclusions Our propensity score analysis in AVR patients showed good hemodynamic characteristics with comparable 30-day mortality rate and complications rates for both investigated RDVs.

Keywords

aortic valve and root - heart valve surgery - cardiac - minimally invasive surgery

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References

References
1 Vahanian A, Otto CM. Risk stratification of patients with aortic stenosis. Eur Heart J 2010; 31 (04) 416-423
2 Frilling B, von Renteln-Kruse W, Riess FC. Evaluation of operative risk in elderly patients undergoing aortic valve replacement: the predictive value of operative risk scores. Cardiology 2010; 116 (03) 213-218
3 Phan K, Tsai YC, Niranjan N. et al. Sutureless aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg 2015; 4 (02) 100-111
4 Brown JM, O'Brien SM, Wu C, Sikora JA, Griffith BP, Gammie JS. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg 2009; 137 (01) 82-90
5 Beckmann A, Meyer R, Lewandowski J, Markewitz A, Harringer W. German Heart Surgery Report 2018: the Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2019; 67 (05) 331-344
6 Leon MB, Smith CR, Mack M. et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363 (17) 1597-1607
7 Mack MJ, Leon MB, Thourani VH. et al. PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019; 380 (18) 1695-1705
8 Di Eusanio M, Phan K. Sutureless aortic valve replacement. Ann Cardiothorac Surg 2015; 4 (02) 123-130
9 Ensminger S, Fujita B, Bauer T. et al. GARY Executive Board. Rapid deployment versus conventional bioprosthetic valve replacement for aortic stenosis. J Am Coll Cardiol 2018; 71 (13) 1417-1428
10 Wahlers TC, Haverich A, Borger MA. et al. Early outcomes after isolated aortic valve replacement with rapid deployment aortic valve. J Thorac Cardiovasc Surg 2016; 151 (06) 1639-1647
11 Laborde F, Fischlein T, Hakim-Meibodi K. et al. Cavalier Trial Investigators. Clinical and haemodynamic outcomes in 658 patients receiving the Perceval sutureless aortic valve: early results from a prospective European multicentre study (the Cavalier Trial). Eur J Cardiothorac Surg 2016; 49 (03) 978-986
12 Barnhart GR, Accola KD, Grossi EA. et al. TRANSFORM Trial Investigators. TRANSFORM (Multicenter Experience with Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) US clinical trial: performance of a rapid deployment aortic valve. J Thorac Cardiovasc Surg 2017; 153 (02) 241-251.e2
13 Shrestha M, Fischlein T, Meuris B. et al. European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patients. Eur J Cardiothorac Surg 2016; 49 (01) 234-241
14 Laufer G, Haverich A, Andreas M. et al. Long-term outcomes of a rapid deployment aortic valve: data up to 5 years. Eur J Cardiothorac Surg 2017; 52 (02) 281-287
15 Liakopoulos OJ, Gerfer S, Weider S. et al. direct comparison of the Edwards Intuity Elite and Sorin Perceval S rapid deployment aortic valves. Ann Thorac Surg 2018; 105 (01) 108-114
16 Rahmanian PB, Eghbalzadeh K, Kaya S. et al. Determination of risk factors for pacemaker requirement following rapid-deployment aortic valve replacement. Interact Cardiovasc Thorac Surg 2018; 27 (02) 215-221
17 Berretta P, Andreas M, Carrel TP. et al. Minimally invasive aortic valve replacement with sutureless and rapid deployment valves: a report from an international registry (Sutureless and Rapid Deployment International Registry). Eur J Cardiothorac Surg 2019; 56 (04) 793-799
18 Borger MA, Dohmen PM, Knosalla C. et al. Haemodynamic benefits of rapid deployment aortic valve replacement via a minimally invasive approach: 1-year results of a prospective multicentre randomized controlled trial. Eur J Cardiothorac Surg 2016; 50 (04) 713-720
19 Di Eusanio M, Phan K, Berretta P. et al. Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR): early results from 3343 patients. Eur J Cardiothorac Surg 2018; 54 (04) 768-773
20 Salis S, Mazzanti VV, Merli G. et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22 (06) 814-822
21 D'Onofrio A, Salizzoni S, Filippini C. et al. Surgical aortic valve replacement with new-generation bioprostheses: sutureless versus rapid-deployment. J Thorac Cardiovasc Surg 2019; S0022-5223 (19)30977-8