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Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography
Author(s) -
Rubino Antonino S.,
Biancari Fausto,
Caruso Vincenzo,
Lavanco Vincenzo,
Privitera Fiorella,
Rinaldi Ivana,
Sanfilippo Maria,
Millan Giovanni,
D'Urso Lucia V.,
Castorina Sergio,
Mignosa Carmelo
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13735
Subject(s) - medicine , cardiology , ejection fraction , hemodynamics , aortic valve replacement , dobutamine , stroke volume , prosthesis , aortic valve , surgery , stenosis , heart failure
Objectives The aim of this study was to evaluate the hemodynamic performance of a sutureless bioprosthesis under high workload at mid‐term follow‐up. Methods Thirty‐two patients who underwent isolated aortic valve replacement with a Perceval sutureless bioprosthesis with a minimum follow‐up of 1 year were enrolled in this study. S size prosthesis was deployed in 10 patients (31.3%), M size in 9 (28.1%), L size in 8 (25%) and XL size in 5 (15.6%). Effective orifice area ( EOA ), EOA index ( EOA i), and transvalvular gradients were assessed at rest and during dobutamine stress echocardiography ( DSE ) a median of 19.5 months after surgery. Results Dobutamine stress echocardiography ( DSE ) significantly increased heart rate, stroke volume, ejection fraction, and transvalvular gradients (peak gradient, 24.0 ± 7.6 vs 38.7 ± 13.6 mm Hg, P < .001; mean gradient, 12.6 ± 4.2 vs 19.8 ± 8.3, P < .001). When compared to baseline, estimated valve areas significantly increased at follow‐up ( EOA , 1.48 ± 0.46 vs 2.06 ± 0.67, P < .001; EOA i, 0.84 ± 0.26 vs 1.17 ± 0.37, P < .001). Mean percentage increase in EOA i was 40.3% ± 28.0%. S size prostheses had the highest increase in EOA 1, but the difference was not significant (S 46.0% ± 27.5% vs M 45.4% ± 34.5% vs L 32.7% ± 26.4% vs XL 32.1% ± 20.5%, P = .66). Severe patient‐prosthesis mismatch ( EOA i ≤ 0.65 cm 2 /m 2 ) was present at rest in 8 patients (25%), but only in one patient (3.1%) during DSE . Conclusions The Perceval sutureless bioprosthesis demonstrated good hemodynamics at rest and under high workload. The significant increase in EOA i during DSE suggests the potential advantages of Perceval sutureless bioprostheses in case of small aortic annulus or when patient‐prosthesis mismatch is anticipated.