Vol. 20 No. 2 (2016)
RECONSTRUCTIVE SURGERY OF THE AORTIC ROOT

Truly stentless xenopericardial aortic valve replacement as an alternative to standard aortic valve replacements

PDF (Русский)
  • A. Nesmachnyy,
  • Yu. Kareva,
  • T. Ruzmatov,
  • A. Chernyavskiy
A. Nesmachnyy
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
Bio
Yu. Kareva
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
T. Ruzmatov
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
A. Chernyavskiy
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2016-2-58-65

Published 2016-08-17

Keywords

  • aorta,
  • aortic valve replacement,
  • truly stentless valve

How to Cite

Nesmachnyy, A., Kareva, Y., Ruzmatov, T., & Chernyavskiy, A. (2016). Truly stentless xenopericardial aortic valve replacement as an alternative to standard aortic valve replacements. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 20(2), 58–65. https://doi.org/10.21688/1681-3472-2016-2-58-65

Copyright (c) 2016 Nesmachnyy A.S., Kareva Yu.E., Ruzmatov T.M., Chernyavskiy A.M.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim: The study was to determine the feasibility and safety of truly stentless aortic valve replacement with bovine pericardium sutured directly onto the aortic wall by using a holding device.
Methods: Seven patients with pronounced aortic stenosis and coronary artery disease who underwent aortic valve leaflets plasty with a xenopericardial patch by means of a holding device combined with CABG were recruited.
Results: The aortic valve was successfully re-paired in 7 patients. A normal function of the valve was confirmed by echocardiographic data obtained in all patients. No complications were observed during follow-up. Mean hospital stay was 17 (13; 35) days. No reoperation for the aortic valve was performed during follow-up. Hospital mortality was 0%. Mean follow-up was 759 days. Long-term survival rate was 86%. Freedom from structural valve deterioration, thromboembolism, endocarditis and reoperation ran to 100%. The peak gradient across the aortic valve in the late period was 30 (26; 42) mm Hg, peak speed amounted to 3 (2.8; 3.2), mean aortic regurgitation grade was 1±0.1 degree.
Conclusion: Truly stentless xenopericardial aortic valve replacement is a good alternative to standard aortic valve replacement. This method is safe with regard to freedom from reoperations, degenerative valve changes, thromboembolism, endocarditis in the early and late postoperative periods.

PDF (Русский)

References

  1. Rahimtoola SH. Choice of prosthetic heart valve in adults: an update. Journal of the American College of Cardiology. 2010;55(22):2413-26. http://dx.doi.org/10.1016/j.jacc.2009.10.085
  2. Dunning J, Gao H, Chambers J, Moat N, Murphy G, Pagano D, Bridgewater B. Aortic valve surgery: marked increases in volume and significant decreases in mechanical valve use—an analysis of 41,227 patients over 5 years from the Society for Cardiothoracic Surgery in Great Britain and Ireland National database. Journal of thoracic and cardiovascular surgery. 2011;142(4):776-82. http://dx.doi.org/10.1016/j.jtcvs.2011.04.048
  3. Payne DM, Pavan Koka H, Karanicolas PJ, Chu MW, Dave Nagpal A, Briel M, Lonn EM. Hemodynamic Performance of Stentless Versus Stented Valves: A Systematic Review and Meta‐Analysis. Journal of cardiac surgery. 2008;23(5):556-64. http://dx.doi.org/10.1111/j.1540-8191.2008.00705.x
  4. Kunadian B, Vijayalakshmi K, Thornley AR, de Belder MA, Hunter S, Kendall S, Dunning J. Meta-analysis of valve hemodynamics and left ventricular mass regression for stentless versus stented aortic valves. Annals of thoracic surgery. 2007;84(1):73-8.
  5. Pepper J, Cheng D, Stanbridge R, Ferdinand FD, Jamieson WRE, Stelzer P, Martin J. Stentless versus stented bioprosthetic aortic valves: a consensus statement of the international society of minimally invasive cardiothoracic surgery (ISMICS) 2008. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2009;4(2):49-60.
  6. Chan KJ, Rahman-Haley S, Mittal TK, Gavino JA, Dreyfus GD. Truly stentless autologous pericardial aortic valve replacement: An alternative to standard aortic valve replacement. Journal of thoracic and cardiovascular surgery. 2011;141(1):276-83. http://dx.doi.org/10.1016/j.jtcvs.2010.09.038
  7. Ozaki S, Kawase I, Yamashita H, Uchida S, Nozawa Y, Takatoh M, Kiyohara N. Aortic valve reconstruction using autologous pericardium for ages over 80 years. Asian Cardiovascular and Thoracic Annals. 2014;22(8):903-8. http://dx.doi.org/10.1177/0218492314520748
  8. Gulbins H, Reichenspurner H. Which patients benefit from stentless aortic valve replacement? The Annals of thoracic surgery. 2009;88(6):2061-8. http://dx.doi.org/10.1016/j.athoracsur.2009.06.060
  9. Cheng A, Dagum P, Miller DC. Aortic root dynamics and surgery: from craft to science. Philosophical Transactions of the Royal Society of London B: Biological Sciences. 2007;362(1484):1407-19. http://dx.doi.org/10.1098/rstb.2007.2124
  10. Rodríguez F, Green GR, Dagum P, Nistal JF, Harrington KB, Daughters GT, Miller DC. Left ventricular volume shifts and aortic root expansion during isovolumic contraction. Journal of heart valve disease. 2006;15(4):465-73.
  11. Lansac E, Lim HS, Shomura Y, Lim KH, Rice NT, Goetz W, Duran CMG. A four-dimensional study of the aortic root dynamics. European journal of cardio-thoracic surgery. 2002;22(4):497-503.
  12. Grabenwöger M, Fitzal F, Gross C, Hutschala D, Böck P, Brucke P, Wolner E. Different modes of degeneration in autologous and heterologous heart valve prostheses. Journal of heart valve disease. 2000;9(1):104-9.
  13. Thubrikar MJ, Deck JD, Aouad J, Nolan SP. Role of mechanical stress in calcification of aortic bioprosthetic valves. Journal of Thoracic and Cardiovascular Surgery. 1983;86(1):115-25.
  14. Gross C, Simon P, Grabenwöger M, Mair R, Sihorsch K, Kypta A, Brücke P. Midterm results after aortic valve replacement with the autologous tissue cardiac valve. European journal of cardio-thoracic surgery. 1999;16(5):533-9.
  15. Chernyavskiy AM, Khvan DS, Alsov SA, Sirota DA, Lyashenko MM. Results of aortic root reimplantation in patients with ascending aortic aneurysm and concomitant aortic insufficiency. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2015;19(4):38-47.
  16. El-Hamamsy I, Clark L, Stevens LM, Sarang Z, Melina G, Takkenberg JJ, Yacoub MH. Late outcomes following freestyle versus homograft aortic root replacement: results from a prospective randomized trial. Journal of the American College of Cardiology. 2010;55(4):368-76. http://dx.doi.org/10.1016/j.jacc.2009.09.030