Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis
ABSTRACT INTRODUCTION: The conventional aortic valve replacement is the treatment of choice for symptomatic severe aortic stenosis. Transcatheter technique is a viable alternative with promising results for inoperable patients. Sutureless bioprostheses have shown benefits in high-risk patients, su...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Sociedade Brasileira de Cirurgia Cardiovascular
2015-10-01
|
| Series: | Brazilian Journal of Cardiovascular Surgery |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382015000500515&lng=en&tlng=en |
| _version_ | 1828816217414041600 |
|---|---|
| author | Walter J. Gomes João Carlos Leal Fabio Biscegli Jatene Nelson A. Hossne Jr Renata Gabaldi Glaucia Basso Frazzato Guilherme Agreli Domingo M. Braile |
| author_facet | Walter J. Gomes João Carlos Leal Fabio Biscegli Jatene Nelson A. Hossne Jr Renata Gabaldi Glaucia Basso Frazzato Guilherme Agreli Domingo M. Braile |
| author_sort | Walter J. Gomes |
| collection | DOAJ |
| description | ABSTRACT INTRODUCTION: The conventional aortic valve replacement is the treatment of choice for symptomatic severe aortic stenosis. Transcatheter technique is a viable alternative with promising results for inoperable patients. Sutureless bioprostheses have shown benefits in high-risk patients, such as reduction of aortic clamping and cardiopulmonary bypass, decreasing risks and adverse effects. OBJECTIVE: The objective of this study was to experimentally evaluate the implantation of a novel balloon-expandable aortic valve with sutureless bioprosthesis in sheep and report the early clinical application. METHODS: The bioprosthesis is made of a metal frame and bovine pericardium leaflets, encapsulated in a catheter. The animals underwent left thoracotomy and the cardiopulmonary bypass was established. The sutureless bioprosthesis was deployed to the aortic valve, with 1/3 of the structure on the left ventricular face. Cardiopulmonary bypass, aortic clamping and deployment times were recorded. Echocardiograms were performed before, during and after the surgery. The bioprosthesis was initially implanted in an 85 year-old patient with aortic stenosis and high risk for conventional surgery, EuroSCORE 40 and multiple comorbidities. RESULTS: The sutureless bioprosthesis was rapidly deployed (50-170 seconds; average=95 seconds). The aortic clamping time ranged from 6-10 minutes, average of 7 minutes; the mean cardiopulmonary bypass time was 71 minutes. Bioprostheses were properly positioned without perivalvar leak. In the first operated patient the aortic clamp time was 39 minutes and the patient had good postoperative course. CONCLUSION: The deployment of the sutureless bioprosthesis was safe and effective, thereby representing a new alternative to conventional surgery or transcatheter in moderate- to high-risk patients with severe aortic stenosis. |
| first_indexed | 2024-12-12T10:59:02Z |
| format | Article |
| id | doaj.art-1c80532ee9244b2e845eef852fbdfca5 |
| institution | Directory Open Access Journal |
| issn | 1678-9741 |
| language | English |
| last_indexed | 2024-12-12T10:59:02Z |
| publishDate | 2015-10-01 |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| record_format | Article |
| series | Brazilian Journal of Cardiovascular Surgery |
| spelling | doaj.art-1c80532ee9244b2e845eef852fbdfca52022-12-22T00:26:34ZengSociedade Brasileira de Cirurgia CardiovascularBrazilian Journal of Cardiovascular Surgery1678-97412015-10-0130551551910.5935/1678-9741.20150072S0102-76382015000500515Experimental Study and Early Clinical Application Of a Sutureless Aortic BioprosthesisWalter J. GomesJoão Carlos LealFabio Biscegli JateneNelson A. Hossne JrRenata GabaldiGlaucia Basso FrazzatoGuilherme AgreliDomingo M. BraileABSTRACT INTRODUCTION: The conventional aortic valve replacement is the treatment of choice for symptomatic severe aortic stenosis. Transcatheter technique is a viable alternative with promising results for inoperable patients. Sutureless bioprostheses have shown benefits in high-risk patients, such as reduction of aortic clamping and cardiopulmonary bypass, decreasing risks and adverse effects. OBJECTIVE: The objective of this study was to experimentally evaluate the implantation of a novel balloon-expandable aortic valve with sutureless bioprosthesis in sheep and report the early clinical application. METHODS: The bioprosthesis is made of a metal frame and bovine pericardium leaflets, encapsulated in a catheter. The animals underwent left thoracotomy and the cardiopulmonary bypass was established. The sutureless bioprosthesis was deployed to the aortic valve, with 1/3 of the structure on the left ventricular face. Cardiopulmonary bypass, aortic clamping and deployment times were recorded. Echocardiograms were performed before, during and after the surgery. The bioprosthesis was initially implanted in an 85 year-old patient with aortic stenosis and high risk for conventional surgery, EuroSCORE 40 and multiple comorbidities. RESULTS: The sutureless bioprosthesis was rapidly deployed (50-170 seconds; average=95 seconds). The aortic clamping time ranged from 6-10 minutes, average of 7 minutes; the mean cardiopulmonary bypass time was 71 minutes. Bioprostheses were properly positioned without perivalvar leak. In the first operated patient the aortic clamp time was 39 minutes and the patient had good postoperative course. CONCLUSION: The deployment of the sutureless bioprosthesis was safe and effective, thereby representing a new alternative to conventional surgery or transcatheter in moderate- to high-risk patients with severe aortic stenosis.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382015000500515&lng=en&tlng=enAortic Valve, SurgeryHeart Valves, SurgeryAortic Valve StenosisBioprosthesis |
| spellingShingle | Walter J. Gomes João Carlos Leal Fabio Biscegli Jatene Nelson A. Hossne Jr Renata Gabaldi Glaucia Basso Frazzato Guilherme Agreli Domingo M. Braile Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis Brazilian Journal of Cardiovascular Surgery Aortic Valve, Surgery Heart Valves, Surgery Aortic Valve Stenosis Bioprosthesis |
| title | Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis |
| title_full | Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis |
| title_fullStr | Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis |
| title_full_unstemmed | Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis |
| title_short | Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis |
| title_sort | experimental study and early clinical application of a sutureless aortic bioprosthesis |
| topic | Aortic Valve, Surgery Heart Valves, Surgery Aortic Valve Stenosis Bioprosthesis |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382015000500515&lng=en&tlng=en |
| work_keys_str_mv | AT walterjgomes experimentalstudyandearlyclinicalapplicationofasuturelessaorticbioprosthesis AT joaocarlosleal experimentalstudyandearlyclinicalapplicationofasuturelessaorticbioprosthesis AT fabiobisceglijatene experimentalstudyandearlyclinicalapplicationofasuturelessaorticbioprosthesis AT nelsonahossnejr experimentalstudyandearlyclinicalapplicationofasuturelessaorticbioprosthesis AT renatagabaldi experimentalstudyandearlyclinicalapplicationofasuturelessaorticbioprosthesis AT glauciabassofrazzato experimentalstudyandearlyclinicalapplicationofasuturelessaorticbioprosthesis AT guilhermeagreli experimentalstudyandearlyclinicalapplicationofasuturelessaorticbioprosthesis AT domingombraile experimentalstudyandearlyclinicalapplicationofasuturelessaorticbioprosthesis |