redo aortic valve replacement: the sutureless approach
TRANSCRIPT
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
There are many questions with more than one answer in cardiac surgery…
Without debate, there would be no progress!
Redos
We are looking for new ideas to keep it simple and safe
CAVALIER TRIAL – update at December 15, 2011
558 patients
(from Feb 2010)
83 pts. in
Nuremberg
13 pts. in Redos
(15,7%)
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
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
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
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????
Intraoperative data
1 CABG lesion
1 intraoperative explant
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%)
Follow up 8,5 months (up to 15 months)
Freedom from reoperation and/or endocarditis 100%
no exitus
no events
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
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
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
Nuremberg - Germany
Thank you! Danke! Grazie!