Research Article
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Comparison of Early Results of Mechanical Valve and Sutureless Biological Valve Replacement in Patients with Symptomatic Aortic Stenosis

Year 2019, Volume: 21 Issue: 1, 37 - 41, 30.04.2019
https://doi.org/10.18678/dtfd.506409

Abstract

Aim: In this study, it is aimed to compare the early results of sutureless bioprosthetic aortic valve and mechanical valve replacement in high-risk patients with severe symptomatic aortic stenosis.

Material and Methods: Between January 2015 and September 2018, 34 (18 males, 16 females) patients who underwent sutureless bioprosthetic aortic valve replacement (Edwards, Intuity) and 50 (29 males, 21 females) mechanical aortic valve replacement (Medtronic, ATS) were included in the study. It is aimed to compare the demographic data and postoperative 1st month data of patients.

Results: In patients with mechanical valve insertion, ejection fraction (EF) was 60 (38-69), New York Heart Association (NYHA) classification was 3 (2-4), EuroSCORE was 3 (0-7) and mean gradient was 56 (40-75) mmHg, while in patients with sutureless valve EF was determined as 52 (33-68), NYHA as 4 (2-4), EuroSCORE as 5 (0-7) and mean gradient as 60 (40-95) mmHg. In patients who underwent mechanical aortic valve replacement, 9 patients underwent coronary bypass, 7 patients underwent mitral valve replacement and 2 patients underwent tricuspid ring annuloplasty, simultaneously. In patients who underwent sutureless valve replacement, 8 patients underwent coronary bypass, 1 patient underwent mitral valve replacement and 1 patient underwent mitral repair. In both groups, a patient died within the first 30 days postoperatively.

Conclusion: Advanced age and the presence of comorbidities increase the mortality and morbidity in operations due to aortic stenosis. Sutureless aortic valve replacement can be safely used in high-risk patients with low mortality and morbidity, excellent hemodynamics and short implantation time.

References

  • Eichstaedt HC, Easo J, Härle T, Dapunt OE. Early singlecenter experience in sutureless aortic valve implantation in 120 patients. J Thorac Cardiovasc Surg. 2014;147(1):370-5.
  • Altintas G, Diken AI, Hanedan O, Yurdakok O, Ozyalcin S, Kucuker SA, et al. The Sorin Freedom SOLO stentless tissue valve: early outcomes after aortic valve replacement. Tex Heart Inst J. 2013;40(1):50-5.
  • Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24(13):1231-43.
  • Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597-607.
  • Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609-20.
  • Webb JG, Pasupati S, Humphries K, Thompson C, Altwegg L, Moss R, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007;116(7):755-63.
  • Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686-95.
  • Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187-98.
  • Shrestha M, Folliguet T, Meuris B, Dibie A, Bara C, Herregods MC, et al. Sutureless Perceval S aortic valve replacement: a multicenter, prospective pilot trial. J Heart Valve Dis. 2009;18(6):698-702.
  • 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(1):82-90.
  • Walther T, Blumenstein J, van Linden A, Kempfert J. Contemporary management of aortic stenosis: surgical aortic valve replacement remains the gold standard. Heart. 2012;98(Suppl 4):iv23-9.
  • Yan TD, Cao C, Martens-Nielsen J, Padang R, Ng M, Vallely MP, et al. Transcatheter aortic valve implantation for high-risk patients with severe aortic stenosis: A systematic review. J Thorac Cardiovasc Surg. 2010;139(6):1519-28.
  • Folliguet TA, Laborde F, Zannis K, Ghorayeb G, Haverich A, Shrestha M. Sutureless perceval aortic valve replacement: results of two European centers. Ann Thorac Surg. 2012;93(5):1483-8.
  • Ranucci M, Frigiola A, Menicanti L, Castelvecchio S, de Vincentiis C, Pistuddi V. Aortic cross-clamp time, new prostheses, and outcome in aortic valve replacement. J Heart Valve Dis. 2012;21(6):732-9.
  • Dawkins S, Hobson AR, Kalra PR, Tang AT, Monro JL, Dawkins KD. Permanent pacemaker implantation after isolated aortic valve replacement: incidence, indications, and predictors. Ann Thorac Surg. 2008;85(1):108-12.
  • Mazine A, Teoh K, Bouhout I, Bhatnagar G, Pelletier M, Voisine P, et al. Sutureless aortic valve replacement: a Canadian multicentre study. Can J Cardiol. 2015;31(1):63-8.
  • Goldenberg G, Kusniec J, Kadmon E, Golovchiner G, Zabarsky R, Nevzorov R, et al. Pacemaker mplantation after transcatheter aortic valve implantation. Am J Cardiol. 2013;112(10):1632-4.
  • Di Eusanio M, Fortuna D, De Palma R, Dell’Amore A, Lamarra M, Contini GA, et al. Aortic valve replacement: results and predictors of mortality from a contemporary series of 2256 patients. J Thorac Cardiovasc Surg. 2011;141(4):940-7.
  • Kocher AA, Laufer G, Haverich A, Shrestha M, Walther T, Misfeld M, et al. One-year outcomes of the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the EDWARDS INTUITY Valve System. J Thorac Cardiovasc Surg. 2013;145(1):110-5.

Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması

Year 2019, Volume: 21 Issue: 1, 37 - 41, 30.04.2019
https://doi.org/10.18678/dtfd.506409

Abstract

Amaç: Bu çalışmada ileri semptomatik aort darlığı bulunan yüksek riskli hastalarda dikişsiz biyoprotez aort kapak ve mekanik kapak replasmanı erken dönem sonuçlarının karşılaştırılması amaçlandı.

Gereç ve Yöntemler: Ocak 2015 ve Eylül 2018 tarihleri arasında 34 (18 Erkek, 16 Kadın) dikişsiz biyoprotez aort kapak replasmanı (Edwards, Intuity) ve 50 (29 Erkek, 21 Kadın) mekanik aort kapak replasmanı (Medtronic, ATS) yapılan hasta çalışmaya alındı. Hastaların demografik verileri ve postoperatif 1. ay verilerinin karşılaştırılması amaçlandı.

Bulgular: Mekanik kapak takılan hastalarda ejeksiyon fraksiyonu (EF) 60 (38-69), New York Kalp Cemiyeti (New York Heart Association, NYHA) sınıflaması 3 (2-4), EuroSCORE 3 (0-7) ve ortalama gradiyent 56 (40-75) mmHg iken, dikişsiz kapak kullanılan hastalarda ise EF 52 (33-68), NYHA 4 (2-4), EuroSCORE 5 (0-7) ve ortalama gradiyent 60 (40-95) mmHg olarak saptandı. Mekanik aort kapak replasmanı yapılan hastalarda eş zamanlı olarak 9 hastaya koroner bypass, 7 hastaya mitral kapak replasmanı ve 2 hastaya triküspid ring anüloplasti yapılmıştır. Dikişsiz kapak replasmanı yapılan grupta 8 hastaya koroner bypass, 1 hastaya mitral kapak replasmanı ve 1 hastaya mitral tamir işlemi uygulanmıştır. Her iki grupta da 1 hasta postoperatif ilk 30 gün içerisinde ex olmuştur.

Sonuç: Aort darlığına bağlı operasyonlarda ileri yaş ve komorbiditelerin varlığı mortalite ve morbiditeyi arttırmaktadır. Dikişsiz aort kapağı replasmanı yüksek riskli hastalarda düşük mortalite ve morbidite, mükemmel hemodinami ve kısa implantasyon süresi ile güvenli bir biçimde kullanılabilir.

References

  • Eichstaedt HC, Easo J, Härle T, Dapunt OE. Early singlecenter experience in sutureless aortic valve implantation in 120 patients. J Thorac Cardiovasc Surg. 2014;147(1):370-5.
  • Altintas G, Diken AI, Hanedan O, Yurdakok O, Ozyalcin S, Kucuker SA, et al. The Sorin Freedom SOLO stentless tissue valve: early outcomes after aortic valve replacement. Tex Heart Inst J. 2013;40(1):50-5.
  • Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24(13):1231-43.
  • Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597-607.
  • Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609-20.
  • Webb JG, Pasupati S, Humphries K, Thompson C, Altwegg L, Moss R, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007;116(7):755-63.
  • Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686-95.
  • Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187-98.
  • Shrestha M, Folliguet T, Meuris B, Dibie A, Bara C, Herregods MC, et al. Sutureless Perceval S aortic valve replacement: a multicenter, prospective pilot trial. J Heart Valve Dis. 2009;18(6):698-702.
  • 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(1):82-90.
  • Walther T, Blumenstein J, van Linden A, Kempfert J. Contemporary management of aortic stenosis: surgical aortic valve replacement remains the gold standard. Heart. 2012;98(Suppl 4):iv23-9.
  • Yan TD, Cao C, Martens-Nielsen J, Padang R, Ng M, Vallely MP, et al. Transcatheter aortic valve implantation for high-risk patients with severe aortic stenosis: A systematic review. J Thorac Cardiovasc Surg. 2010;139(6):1519-28.
  • Folliguet TA, Laborde F, Zannis K, Ghorayeb G, Haverich A, Shrestha M. Sutureless perceval aortic valve replacement: results of two European centers. Ann Thorac Surg. 2012;93(5):1483-8.
  • Ranucci M, Frigiola A, Menicanti L, Castelvecchio S, de Vincentiis C, Pistuddi V. Aortic cross-clamp time, new prostheses, and outcome in aortic valve replacement. J Heart Valve Dis. 2012;21(6):732-9.
  • Dawkins S, Hobson AR, Kalra PR, Tang AT, Monro JL, Dawkins KD. Permanent pacemaker implantation after isolated aortic valve replacement: incidence, indications, and predictors. Ann Thorac Surg. 2008;85(1):108-12.
  • Mazine A, Teoh K, Bouhout I, Bhatnagar G, Pelletier M, Voisine P, et al. Sutureless aortic valve replacement: a Canadian multicentre study. Can J Cardiol. 2015;31(1):63-8.
  • Goldenberg G, Kusniec J, Kadmon E, Golovchiner G, Zabarsky R, Nevzorov R, et al. Pacemaker mplantation after transcatheter aortic valve implantation. Am J Cardiol. 2013;112(10):1632-4.
  • Di Eusanio M, Fortuna D, De Palma R, Dell’Amore A, Lamarra M, Contini GA, et al. Aortic valve replacement: results and predictors of mortality from a contemporary series of 2256 patients. J Thorac Cardiovasc Surg. 2011;141(4):940-7.
  • Kocher AA, Laufer G, Haverich A, Shrestha M, Walther T, Misfeld M, et al. One-year outcomes of the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the EDWARDS INTUITY Valve System. J Thorac Cardiovasc Surg. 2013;145(1):110-5.
There are 19 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Özcan Gür 0000-0001-9321-1699

Selami Gürkan 0000-0001-5391-9270

Publication Date April 30, 2019
Submission Date January 1, 2019
Published in Issue Year 2019 Volume: 21 Issue: 1

Cite

APA Gür, Ö., & Gürkan, S. (2019). Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması. Duzce Medical Journal, 21(1), 37-41. https://doi.org/10.18678/dtfd.506409
AMA Gür Ö, Gürkan S. Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması. Duzce Med J. April 2019;21(1):37-41. doi:10.18678/dtfd.506409
Chicago Gür, Özcan, and Selami Gürkan. “Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak Ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması”. Duzce Medical Journal 21, no. 1 (April 2019): 37-41. https://doi.org/10.18678/dtfd.506409.
EndNote Gür Ö, Gürkan S (April 1, 2019) Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması. Duzce Medical Journal 21 1 37–41.
IEEE Ö. Gür and S. Gürkan, “Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması”, Duzce Med J, vol. 21, no. 1, pp. 37–41, 2019, doi: 10.18678/dtfd.506409.
ISNAD Gür, Özcan - Gürkan, Selami. “Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak Ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması”. Duzce Medical Journal 21/1 (April 2019), 37-41. https://doi.org/10.18678/dtfd.506409.
JAMA Gür Ö, Gürkan S. Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması. Duzce Med J. 2019;21:37–41.
MLA Gür, Özcan and Selami Gürkan. “Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak Ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması”. Duzce Medical Journal, vol. 21, no. 1, 2019, pp. 37-41, doi:10.18678/dtfd.506409.
Vancouver Gür Ö, Gürkan S. Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması. Duzce Med J. 2019;21(1):37-41.