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Pericardial stentless bioprosthesis
Preliminary results of a modified procedure for implantation
Y. De Bruyne, B. El Nakadi & M. JorisHopitaux civils du CPAS de Charleroi, Belgium.
Pericardial stentless bioprosthesis
• 37 patients• Male / female: 26/11 • Age: 68 ± 6 ( 53 - 83 ) • Aortic valve lesions:
Stenosis: 16 (43%)
Regurgitation: 10 (27%)
Mixed: 11 (13%)• Endocarditis: 5 (13%)
Pericardial stentless bioprosthesis
– Size of implanted valves:• 21 mm 1• 23 mm 7• 25 mm 12• 27 mm 17
– Associated procedures:• CABG 13• Mitral repair 1
Operative data
Pericardial stentless bioprosthesis
• Group A: Classical– Classical subcoronary implantation (8/37)
• Group B: Banding– Addition of peri-aortic banding (19/37)
• Group C: Vascular prosthesis– Association with replacement of a dilated ascending aorta
(10/37)
Operative groups
Pericardial stentless bioprosthesis
• 8 patients• Regurgitation:
1 mild
1 severe ( reoperated )
Reconsideration of the operative technique
Group A: Classical
Pericardial stentless bioprosthesisImplantation stentless valve dysfunction
Centro-valvular regurgitation
Control of sinotubular
junction diameter
Vascular prosthesisBanding
Pericardial stentless bioprosthesisImplantation stentless valve dysfunction
Centro-valvular regurgitation
Control of sinotubular
junction diameter
Control of commissural
alignment
Vascular prosthesisBanding
Pericardial stentless bioprosthesis
Vascular prosthesis
Banding
Group B Group C
Dilated aorta
Non dilated aorta
Pericardial stentless bioprosthesisImplantation stentless valve dysfunction
Transvalvular gradient
Suppression ofperivalvular
space
Reduction of valvular
obstruction
Adequate scallopping GRF glue
Pericardial stentless bioprosthesisEffect of scallopping on geometry
Cylindrical Possibility of noncylindrical implantation
Pericardial stentless bioprosthesisImplantation stentless valve dysfunction
Centro-valvular regurgitation Transvalvular gradient
Control of sinotubular
junction diameter
Control of commissural
alignment
Vascular prosthesis
Suppression ofperivalvular
space
Banding
Reduction of valvular
obstruction
Adequate scallopping GRF glue
Pericardial stentless bioprosthesis
• S-shaped aortotomy
• Aortic wall extensively freed of calcifications
• Size of the prosthesis defined by the diameter of
the aortic annulus
• Trimming of the inferior rim of the prosthesis
• Inflow suture line: 3 running sutures (Baratt-Boyes)
• Scallopping of the three sinuses
• Outflow suture line: 3 running sutures
Group B: Banding (19 patients )
Pericardial stentless bioprosthesis
• Dacron strip length :
C = 3,5 * [prosthesis diameter]
(perimeter + aortic wall thickness)
• GRF Glue
• Extra-aortic knots of the distal suture line anchoring
the Dacron banding
• Closure of the aortotomy
• Fastening of the banding
Group B: Banding (19 patients )
Pericardial stentless bioprosthesis
• Dilated ascending aorta (more than 40 mm)
• Transsection at the sinotubular junction
• Valve replacement (± plicatures of the aortic wall)
• Vascular prosthesis (1 mm larger than the valve)
• Proximal running suture supporting the valvular
commissures
• Distal running suture line
Group C: Vascular prosthesis (10 patients )
Pericardial stentless bioprosthesis
Cross-clamping time
Simple valve replacement
Replacement associated with
other procedures
Group A 95 ± 20 107 ± 14
Group B 93 ± 18 119 ± 17
Group C 98 ± 15 140
Pericardial stentless bioprosthesis
group A group B group C
Number of patients 8 19 10
Early mortality 1 pulmonary 1 sepsis 1 pulmonary
13% 5% 10%
Late mortality 1 cardiogenic 1 pulmonary 0
13% 5% 0%
Valve related mortality 0 0 0
Survival 75% 89% 90%
mean follow-up 22 months 12 months 12 months
Survival
Pericardial stentless bioprosthesis
group A group B group C
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Post-op 7/8 100% 0% 0% 17/19 100% 0% 9/10 100%
3-6 months 4/6 50% 25% 25% 14/18 100% 0% 6/9 100%
> 1 year 3/5 100% 0% 0% 6/17 83% 17% 3/9 100%
Echocardiographic valve regurgitation
Pericardial stentless bioprosthesis
• The pericardial stentless bioprosthesis can be used in any pathologic condition requiering aortic valve replacement.
• An appropriate peri-aortic banding seems to secure an adequate geometrical valve implantation.
• Combined replacement of the aortic valve and a part of the ascending aorta seems to be a good alternative for a root replacement.
Conclusion
Pericardial stentless bioprosthesis
group A group B group C
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Post-op 7/8 86% 14% 0% 0% 17/19 82% 18% 0% 9/10 100% 0%
3-6 months 4/6 25% 25% 25% 25% 14/18 79% 21% 0% 6/9 83% 17%
> 1 year 3/5 67% 33% 0% 0% 6/17 83% 0% 17% 3/9 67% 33%
Echocardiographic valve regurgitation
Pericardial stentless bioprosthesisControl of
sinotubular junction diameter
Cylindrical configuration of the prosthesis
Pericardial stentless bioprosthesisControl of
commissuralalignment
Cylindrical configuration of the prosthesis
Pericardial stentless bioprosthesis
Suppression ofperivalvular
space
Reduction of valvular
obstruction
Adequate scallopping
GRF glue