Annals of Thoracic Surgery
Annals of Thoracic Surgery
5 years ago

Increased Gradients After Aortic Valve Replacement With The Perceval Valve: The Role of Oversizing

Significant underexpansion or distortion of valved stents may be associated with altered leaflet function, leading to increased transprosthetic gradients and, possibly, early structural degeneration. We investigated the relationship between a computed tomography (CT) measure of the degree of oversizing and the early haemodynamic and clinical outcomes in patients undergoing aortic valve replacement with the Perceval sutureless aortic valve. Methods The degree of oversizing of the implanted prosthesis was calculated as the ratio between the patients' aortic annulus cross-sectional area (CSA) and the ex-vivo CSA of the implanted prosthesis in 151 perceval patients that had a preoperative cardiac CT. This value was then entered in a multivariate analysis to ascertain its role as a predictor of increased postoperative gradient. Results The operative mortality was 1.3%. Procedural success, defined as having a normofunctioning valve in the proper anatomical location, was achieved in 150 patients (99.3%). The mean transprosthetic gradient was 13.4±5.0 mmHg, and twenty-three patients (15.2%) showed a gradient ≥ 20 mmHg at discharge or at the 1 month follow-up. The degree of oversizing of the implanted prosthesis was the single, most important predictor of increased postoperative gradient (OR:1.264; 95% CI:1.147–1.394; p<0.0001). Interestingly, other relevant factors (patients' BSA, prosthesis size) were not associated with increased gradients. Conclusions Our study demonstrates that in Perceval patients excessive oversizing should be avoided, and suggests that a different sizing algorithm, possibly based on cardiac CT, should be developed. Further studies are needed to optimize the sizing strategy for the Perceval S valve.

Publisher URL: www.sciencedirect.com/science

DOI: S0003497518300845

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