The Hemodynamic Performance of the Perceval Sutureless Aortic Valve in a Propensity-Matched Comparison to the Carpentier-Edwards Perimount and Perimount Magna Ease Valves for Aortic Valve Replacement.

OBJECTIVES: The Perceval valve was shown to facilitate minimal-invasive operations and shorten operative times. We aimed to compare the early results of the Perceval valve to those of well-established valves, namely the Carpentier-Edwards Perimount and Perimount Magna Ease valve protheses, in terms of their clinical and hemodynamic performances. METHODS: This is a single-center, retrospective, observational cohort study. For every patient operated with a Perceval valve, the last patient before and the next following patient receiving a Perimount valve was included in a control group leading to a 2:1 ratio (Perimount:Perceval). A propensity score matching was used and a subgroup analysis was performed to compare early and late Perceval patients as the sizing technique was changed over time. RESULTS: From November 2013 to November 2017, 423 patients were identified. These included 141 consecutive patients receiving a Perceval valve through a full- or a hemi-sternotomy. In addition, 282 patients receiving a Perimount or a Magna Ease valve were enrolled. After propensity score matching, 127 matched patients were compared. Operating times were shorter and postoperative transvalvular pressure gradients were lower in the Perceval group (15 vs. 17 mmHg, p = 0.002). There was no difference in mortality and stroke rates. The incidence of new pacemaker implantations was higher in the Perceval group (7.1 vs. 18.9%, p = 0.005), mainly due to a very high incidence in the early phase of our Perceval experience prior to a change in the Perceval implantation technique. Subgroup analysis showed significantly better results in the late Perceval group. CONCLUSION: Surgical outcome was good in both groups. The Perceval valve exhibited lower postoperative gradients, and the need for pacemaker implantation was higher and can be reduced by avoiding oversizing.

Recannulation of the right axillary artery in reoperative proximal thoracic aortic surgery is safe.

OBJECTIVES: To evaluate the safety and efficacy of recannulating the axillary artery in reoperative proximal thoracic aortic surgery. METHODS: Between 2008 and 2020, we evaluated patients who underwent reoperative proximal thoracic aortic surgery. The patients were divided into 2 groups: (i) patients with no previous right axillary artery cannulation (primary cannulation group) and (ii) patients with a previous cannulated right axillary artery (recannulation group). We analysed the intraoperative data, cannulation-related complications, postoperative outcomes and compared the 2 groups (primary cannulation versus recannulation). RESULTS: The patient (n = 132) baseline characteristics did not differ significantly between the 2 groups. There was no statistically significant difference in regard to the duration of surgery, cardiopulmonary bypass, aortic cross-clamp and antegrade cerebral perfusion time nor in regard to the total number of patients with cannulation-related complications between the 2 groups [n = 8 (8.0%) vs n = 1 (3.1%), P = 0.34]. The incidence of iatrogenic axillary artery dissection, iatrogenic aortic dissection, iatrogenic aortic dissection leading to death, axillary artery thrombosis, need for surgical repair, brachial plexus injury rates, malperfusion, high perfusion resistance and hyperperfusion syndrome revealed no significant difference between the 2 groups (P > 0.05). There were 11 (11.0%) cases of stroke in the primary cannulation group and 1 (3.1%) in the recannulation group (P = 0.18). CONCLUSIONS: Recannulation of the right axillary artery in reoperative proximal thoracic aortic surgery is not associated with worse clinical outcomes and can be safely and effectively performed, also representing a preventive and rescue measure. Previous cannulation of the axillary artery should not hinder the decision for recannulation.

Recurrent Cardiac Constriction after Implantation of an Expanded Polytetrafluoroethylene Surgical Membrane.

One of the challenges compounding the complexity of reoperative cardiac surgery is the surgical adhesion, which can be responsible for adverse intraoperative events. Implantation of a substitute neo-pericardium has become a frequently used solution, with currently rising numbers of reoperations. We report the case of a 38-year-old man who developed recurrent delayed cardiac constriction following the implantation of an expanded polytetrafluoroethylene neo-pericardium. Careful preoperative planning is recommended to plan the optimal method of pericardioplasty, taking into account the pros and cons of each available material.

Direct Versus Side Graft Cannulation From the Right Axillary Artery in Thoracic Aortic Surgery.

BACKGROUND: The axillary artery can be cannulated for antegrade cerebral perfusion directly or by employing a prosthetic vascular graft anastomosed to the artery. METHODS: From 2008 until 2019, 688 patients underwent axillary artery cannulation. Of those, 287 underwent direct cannulation and 401 cannulation through a side graft. We identified risk factors for cannulation-related complications, and after propensity score matching, we compared the 2 matched cohorts' cannulation-related and postoperative outcomes. RESULTS: A smaller axillary-artery diameter (odds ratio = 0.70; 95% confidence interval, 0.56-0.87) and emergency surgery (odds ratio = 2.23; 95% confidence interval, 1.27-3.92) were identified as risk factors for cannulation-associated complications. In the propensity score-matched cohorts (n = 266 in each), the number of patients experiencing cannulation-related complications was significantly higher in the direct cannulation group than in the side-graft group (n = 33 [12.4%] versus n = 15 [5.6%]; P = .01). The direct group's incidence of iatrogenic axillary artery dissection was significantly higher (n = 17 [6.4%] versus n = 4 [1.5%] P = .008); their incidence of postoperative stroke was also significantly higher (n = 39 [14.7%] versus n = 21 [7.9%]; P = .025). Patients cannulated with a side graft needed more transfusions of blood products (median [IQR]: 3.0 [1.0-6.0] versus 4.0 [2.0-7.0;] P = .009). CONCLUSIONS: Cannulating the right axillary through a vascular prosthetic graft reduces cannulation-related complications such as iatrogenic axillary artery dissection and lowers stroke rates. To help prevent cannulation-related complications and stroke, we recommend the routine use of a side graft when cannulating the axillary artery.