Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis
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| Natura: | Artículo científico |
| Lingua: | en |
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Sociedade Brasileira de Cirurgia Cardiovascular
2015
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| _version_ | 1876484384761053184 |
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| author | Walter J. Gomes |
| author_facet | Walter J. Gomes |
| contents | Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis Walter J. Gomes João Carlos Leal Fabio Biscegli Jatene Nelson A. Hossne Renata Gabaldi Glaucia Basso Frazzato Guilherme Agreli Domingo M. Braile Medicina Surgery Aortic Valve Heart Valves Bioprosthesis AorticValve Stenosis Introduction: The conventional aortic valve replacement isthe treatment of choice for symptomatic severe aortic stenosis.Transcatheter technique is a viable alternative with promisingresults for inoperable patients. Sutureless bioprostheses haveshown benefits in high-risk patients, such as reduction of aorticclamping and cardiopulmonary bypass, decreasing risks andadverse effects.Objective: The objective of this study was to experimentallyevaluate the implantation of a novel balloon-expandable aorticvalve with sutureless bioprosthesis in sheep and report the earlyclinical application.Methods: The bioprosthesis is made of a metal frame andbovine pericardium leaflets, encapsulated in a catheter. The animalsunderwent left thoracotomy and the cardiopulmonary bypasswas established. The sutureless bioprosthesis was deployed to theaortic valve, with 1/3 of the structure on the left ventricular face.Cardiopulmonary bypass, aortic clamping and deployment timeswere recorded. Echocardiograms were performed before, duringand after the surgery. The bioprosthesis was initially implantedin an 85 year-old patient with aortic stenosis and high risk forconventional surgery, EuroSCORE 40 and multiple comorbidities.Results: The sutureless bioprosthesis was rapidly deployed(50-170 seconds; average=95 seconds). The aortic clamping timeranged from 6-10 minutes, average of 7 minutes; the meancardiopulmonary bypass time was 71 minutes. Bioprostheses wereproperly positioned without perivalvar leak. In the first operatedpatient the aortic clamp time was 39 minutes and the patient hadgood postoperative course.Conclusion: The deployment of the sutureless bioprosthesiswas safe and effective, thereby representing a new alternative toconventional surgery or transcatheter in moderate- to high-riskpatients with severe aortic stenosis. 2015 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398943520003 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.5 Vol.30 |
| format | Artículo científico |
| id | redalyc_398943520003 |
| institution | Redalyc |
| language | en |
| publishDate | 2015 |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| spellingShingle | Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis Walter J. Gomes Medicina Surgery Aortic Valve Heart Valves Bioprosthesis AorticValve Stenosis Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis Walter J. Gomes João Carlos Leal Fabio Biscegli Jatene Nelson A. Hossne Renata Gabaldi Glaucia Basso Frazzato Guilherme Agreli Domingo M. Braile Medicina Surgery Aortic Valve Heart Valves Bioprosthesis AorticValve Stenosis Introduction: The conventional aortic valve replacement isthe treatment of choice for symptomatic severe aortic stenosis.Transcatheter technique is a viable alternative with promisingresults for inoperable patients. Sutureless bioprostheses haveshown benefits in high-risk patients, such as reduction of aorticclamping and cardiopulmonary bypass, decreasing risks andadverse effects.Objective: The objective of this study was to experimentallyevaluate the implantation of a novel balloon-expandable aorticvalve with sutureless bioprosthesis in sheep and report the earlyclinical application.Methods: The bioprosthesis is made of a metal frame andbovine pericardium leaflets, encapsulated in a catheter. The animalsunderwent left thoracotomy and the cardiopulmonary bypasswas established. The sutureless bioprosthesis was deployed to theaortic valve, with 1/3 of the structure on the left ventricular face.Cardiopulmonary bypass, aortic clamping and deployment timeswere recorded. Echocardiograms were performed before, duringand after the surgery. The bioprosthesis was initially implantedin an 85 year-old patient with aortic stenosis and high risk forconventional surgery, EuroSCORE 40 and multiple comorbidities.Results: The sutureless bioprosthesis was rapidly deployed(50-170 seconds; average=95 seconds). The aortic clamping timeranged from 6-10 minutes, average of 7 minutes; the meancardiopulmonary bypass time was 71 minutes. Bioprostheses wereproperly positioned without perivalvar leak. In the first operatedpatient the aortic clamp time was 39 minutes and the patient hadgood postoperative course.Conclusion: The deployment of the sutureless bioprosthesiswas safe and effective, thereby representing a new alternative toconventional surgery or transcatheter in moderate- to high-riskpatients with severe aortic stenosis. 2015 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398943520003 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.5 Vol.30 |
| title | Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis |
| topic | Medicina Surgery Aortic Valve Heart Valves Bioprosthesis AorticValve Stenosis |
| url | https://www.redalyc.org/articulo.oa?id=398943520003 |