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Comparison of Miniinvasive and Full Sternotomy Implantation of New Suturelss Perceval S Aortic Valves.
Tomasz Niklewski, Krzysztof Filipiak, Michael Zembala, Roman Przybylski, Tomasz Kukulski, Marian Zembala.
Silesian Center For Heart Diseases, Zabrze, Poland.

OBJECTIVE:There is an increase of old patients needing aortic Valve surgery. Especially in this age group, a lot of new less-invasive strategies are proposed.The Perceval S bioprosthesis (Sorin BiomedicaCardio) is a self-expanding valve designed to preserve aortic sinuses and sinotubular junction. We report the results of a the safety and efficacy of this stented bioprosthesis in patients undergoing aortic valve implantation with cardiopulmonary bypass and mini-invasive (partial upper sternotomy) and full sternotomy approach. METHOD:32 patients were screened for Perceval S implantation 15 from mini and 17 from median sternotomy aproach. The mean diameter of the native aortic annulus measured In TEE before the operation was 21.9 mm. RESULTS:In the postoperative period most of the patients changed their NYHA class from III and II to II and I (72%), with evident improvement of exercise capacity.The mean transvalvular gradient of All group has changed significantly from 54.5 mmHg before the operation to 13 mm Hg in follow-up. The ejection fraction (EF) was the same before and In follow-up echo: 54.4 and 55%. The value of follow-up mean effective orifice area (EOA) calculated in follow-up transthoracic echo was 1.71cm2, which is a very good value for biological aortic prostheses. Mean cross-clamp times (CCT) including patients who underwent surgery through mini and median sternotomy were, respectively, 54,2 and 49,9 minutes and and extracorporeal circulation times (ECT) 80 and 77,2 minutes (p=NS). There was no significant difference between two groups in count of drainage and time of hospital stay. 31 patients alive in 6 - 36 months of observation. Only one patient of miniinvasive group died in hospital period because of intestinal ischemia followed the cardiac tamponade. CONCLUSIONS:Sutureless aortic bioprostheses bear the potential of easy implantation, reduced ischemic time, and surgical trauma in aortic valve replacement, is hemodynamically excellent prosthesis in selected patients. Due to a simple and fast implantation technique, this valve could guarantee a good operation time safety and efficiacy in combination with a miniinvasive approach.

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