RESUMEN
OBJECTIVES: To evaluate early outcomes of endoscopic aortic valve replacement (AVR) and risks of concomitant procedures done through the same working port. METHODS: At our institution, we performed a data analysis of 342 consecutive patients (from July 2013 to May 2021) who underwent endoscopic AVR with or without associated major procedure. Preoperative, intraoperative, postoperative data were evaluated. Subsequently, we perform a comparative analysis between the isolated and concomitant surgery group. The surgical access was a 3- to 4-cm working port in the second right intercostal space and 3 additional 5-mm mini-ports for the introduction of the thoracoscope, the transthoracic clamp and the vent line. Cardiopulmonary by-pass was achieved through peripheral cannulation. RESULTS: 105 patients (30.7%) underwent combined procedure: 2 coronary artery bypass (1.9%), 21 ascending aorta replacement (19.6%), 41 mitral surgery (38.3%), 16 mitral and tricuspid surgery (15%) and 25 other procedure (27%). Death occurred in 1 patient (0.4%) in the isolated group versus 2 patients (1.9%) in the combined group (P = 0.175). Seven strokes were observed, 4 in isolated procedures (1.7%) and 3 in the concomitant ones (2.85%) (P = 0.481). Surgical revision for bleeding was performed always through the same access in 13 patients (5.4%) versus 11 patients (10.4%) (P = 0.096). Pacemaker implantation was necessary in 5 patients (2.1%) versus 8 patients (7.6%) (P = 0.014). Median intubation time was 5 (2) h vs 6 (8) (P < 0.080). CONCLUSIONS: Through a single working port made for endoscopic AVR, a concomitant procedure may be done without affecting in-hospital mortality and postoperative stroke rate.
RESUMEN
OBJECTIVES: PERIMOUNT Magna Ease (Carpentier-Edwards; PME) prostheses have been widely implanted during the past decade for aortic valve replacement (AVR). Although promising results at midterm follow-up were reported, long-term outcome has yet to be confirmed. On this study we aimed to evaluate long-term results in terms of structural valve degeneration (SVD), major clinical outcomes, long-term hemodynamic valve performance, and left ventricular remodeling. METHODS: From 2010 to 2012, 689 consecutive patients underwent AVR with PME. Complete clinical 10-year follow-up was obtained. The degree of SVD was categorized on the basis of the latest guidelines. Echocardiographic data were analyzed at 1, 5, and 10 years. Competing risk analysis was performed for major events. Cumulative incidence of SVD, reoperation, and endocarditis were also assessed according to prosthetic sizes (19-21-23 mm vs 25-27-29 mm) and age (<65 vs 65-75 vs >75 years old). RESULTS: The overall cumulative incidence reported for SVD ≥2 and reoperation were 3.6% and 1.9% at 10 years, respectively. An early left ventricular reverse remodeling was noted after implantation and confirmed at follow-up. Patients younger than 65 years showed higher cumulative incidence of SVD ≥2 at 10 years compared with patients aged 65 to 75 and older than 75 years (9.7% vs 2.6% vs 2.7%; P = .013), as well as of redo AVR (7.8% vs 3.3% vs 0.4%; P = .002). There was no difference in terms of SVD and redo AVR for different prosthetic size categories (P > .05). The risk of endocarditis was similar among age and size groups. CONCLUSIONS: PME provides very good durability at long-term and could be considered one of the high performing third-generation bioprostheses for AVR.