The authors do not have any conflict of interest to declare.
We carefully read the recent paper by Hammond et al. (1) on the use of
sutureless bioprosthetic valve for homograft failure in the setting of
infective endocarditis (IE).
This article is the latest demonstration that new sutureless and rapid
deployment (RD) valve prostheses are safe and easy-to-use devices for
surgical aortic valve replacement, and indicates their suitability for
different scenarios and peculiar surgical situations as infective
endocarditis (IE).
It is known that IE represents a huge challenge in cardiac surgery,
associated with high in-hospital morbidity and mortality. In this
contest, surgical procedures are technically complex, scarcely
reproducible, and highly dependent from surgeons’ skills. This explains
the need to investigate a new approach using new generation of
bioprosthetic valves, which are known to be technically more
reproducible and more reliable. According to these data, some groups
have begun to implant Perceval sutureless (LivaNova Group) prosthesis in
cases of IE. The study by Rosello-Diez (2) reported a series of nine
patients, with a rate of mortality, paravalvular regurgitation and PM
implantation of 22 %, 11% and 11% respectively.
In the Weymann series (3), including nine patients affected by aoritc IE
and treated with sutureless bioprosthetic valve implantation, the median
EuroSCORE II was 24.5 %, and no case of postoperative mortality, PMi,
or perivalvular regurgitation was described. The mean trans-prosthetic
gradient was 5.5 mmHg.
We have recently published two papers regarding the use of RD prostheses
in patients affected by IE (4-5). One of them (5) described a series of
8 consecutive patients with a mean age of 74.3 ± 7.2 years, affected by
aortic IE and treated with RD bioprosthetic valve implantation. One case
of in-hospital mortality was noted. None of the patients had
post-operative embolic or infective complication. The postoperative
echocardiographic controls indicated a mean transvalvular gradient of
16.7 ± 3.0 mmHg and one case of paravalvular leaks (2 +). Two patients
underwent epigastric permanent pacemaker implantation. During the
follow-up, seven patients were alive, with no evidence of symptoms or
recurrences of endocarditis or embolic episodes. No new paravalvular
leaks were noted, and the mean gradient on the valves was 12.4 ± 3.4
mmHg.
All these experiences suggest few more considerations.
Firstly: Sutureless and RD prostheses implantation require the use of
less foreign materials such as pledgets and stiches and this could be
advantageous in reducing IE recurrences.
Secondly: The higher solidity and radial force of the stent could offer
more stability in cases with annular involvement and abscess requiring
patch reconstruction.
Thirtly: RD and sutureless prostheses implantation does not require
manipulation of the annulus, which has usually been already damaged by
the infective process.
We strongly believe that these devices, applied in uncommon surgical
scenarios, might represent the basis on which international
recommendations and guidelines could be extended and improved to
guarantee the best results for patients.
REFERENCES
- Hammond RFL, Jasionowska S, Awad WI. Aortic valve replacement with
sutureless Perceval S valve: A case report of aortic root homograft
failure in the setting of Streptococcus constellatus endocarditis. J
Card Surg. 2020 Oct;35(10):2829-2831. doi: 10.1111/jocs.14846. Epub
2020 Jul 17. PMID: 32678968.
- Roselló-Díez E, Cuerpo G, Estévez F, Muñoz-Guijosa C, Tauron M, Cuenca
JJ, González-Pinto Á, Padró JM. Use of the Perceval Sutureless Valve
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Aortic Valves Suitable for Severe High-Risk Patients Suffering from
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