Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch
Abstract
:1. Introduction
2. Experimental Section
2.1. Echocardiography
2.2. Surgical Procedure
2.3. Statistical Analysis
3. Results
3.1. Preoperative, Intraoperative, and Postoperative Data
3.2. Trifecta vs. Perceval to Prevent Patient–Prosthesis Mismatch
4. Discussion
4.1. Influence of Moderate PPM on Clinical Outcomes
4.2. PPM Using the Perceval and the Trifecta
4.3. PPM Is Lower Using the Trifecta: Possible Reasons
4.4. Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Clinical Data | Trifecta | Perceval | p Value |
---|---|---|---|
Women | 190 (46.6%) | 85 (60.7%) | 0.004 |
Age, years | 76.7 ± 5.8 | 78.2 ± 6.4 | 0.008 |
Weight, kg | 75.1 ± 12.5 | 73.4 ± 13.7 | 0.17 |
Height, cms | 161.2 ± 8.9 | 159.2 ± 9.4 | 0.03 |
Systemic hypertension | 326 (79.7%) | 107 (76.4%) | 0.40 |
Diabetes | |||
Non-insulin-dependent | 80 (19.6%) | 32 (22.9%) | |
Insulin-dependent | 31 (7.6%) | 14 (10%) | 0.38 |
Dyslipidemia | 220 (53.8%) | 93 (63.4%) | 0.01 |
Body surface area (m2) | 1.8 ± 0.2 | 1.8 ± 0.2 | 0.22 |
Body mass index (kg/m2) | 28.9 ± 4.5 | 29.1 ± 4.9 | 0.83 |
Chronic obstructive pulmonary disease | 62 (15.2%) | 28 (20%) | 0.19 |
Creatinine clearance (mL/min) | 63.3 ± 25.4 | 59.5 ± 28.5 | 0.17 |
Previous stroke | 17 (4.2%) | 14 (10%) | 0.018 |
Poor mobility | 8 (1.9%) | 3 (2.1%) | 1 |
Extracardiac arteriopathy | 43 (10.5%) | 18 (12.9%) | 0.44 |
Previous cardiac surgery | 18 (4.4%) | 10 (7.1%) | 0.26 |
Critical preoperative state | 3 (0.7%) | 1 (0.7%) | 1 |
Cardiac data | |||
Active endocarditis | 21 (5.13%) | 6 (4.29%) | 0.82 |
History of supraventricular arrhythmia | 83 (20.3%) | 26 (18.6%) | 0.71 |
Concomitant coronary disease | 140 (34.2%) | 55 (39.3%) | 0.48 |
Previous acute myocardial infarction < 3 months | 10 (2.4%) | 3 (2.1%) | 1 |
Functional class NYHA | |||
NYHA I | 20 (4.9%) | 1 (0.7%) | |
NYHA II | 160 (39.1%) | 81 (57.9%) | |
NYHA III | 206 (50.4%) | 53 (37.9%) | |
NYHA IV | 23 (5.6%) | 5 (0.04%) | 0.005 |
Echocardiographic parameters | |||
Left ventricular ejection fraction | |||
>50% | 345 (84.4%) | 116 (82.9%) | |
>30% y ≤50% | 48 (11.7%) | 16 (11.4%) | |
≤30% y >20% | 16 (3.9%) | 8 (5.71%) | |
≤20% | 0 (0%) | 0 (0%) | 0.63 |
Interventricular septum > 17mm | 73 (17.8%) | 44 (31.4%) | 0.001 |
Left ventricular outflow tract diameter, mm | 22 ± 2.3 | 20.5 ± 2.4 | <0.001 |
Systolic pulmonary pressure > 55 mmHg | 48 (11.9%) | 9 (6.43%) | 0.004 |
Aortic pathology | |||
Pure stenosis | 312 (76.5%) | 107 (76.9%) | |
Pure insufficiency | 48 (11.8%) | 8 (5.76%) | |
Double lesion | 48 (11.8%) | 24 (17.3%) | 0.046 |
Mean gradient, mmHg | 47.3 ± 14.8 | 44.7 ± 14.5 | 0.11 |
Peak gradient, mmHg | 79.5 ± 21.4 | 75.9 ± 22.9 | 0.16 |
Operation Characteristics | Trifecta | Perceval | p Value |
---|---|---|---|
Non-elective surgery | 90 (22.3%) | 33 (23.6%) | 0.76 |
Prosthetic size | * | ||
19 mm/S | 76 (18.6%) | 33 (23.6%) | |
21 mm/M | 151 (36.9%) | 53 (37.9%) | |
23 mm/L | 132 (32.3%) | 29 (20.7%) | |
25/XL | 38 (9.3%) | 25 (17.9%) | |
27 | 12 (2.9%) | ||
Mitral surgery | 63 (15.4%) | 13 (9.3%) | 0.09 |
Tricuspid surgery | 9 (2.2%) | 3 (2.1%) | 0.63 |
Proximal aortic surgery | 18 (4.4%) | 1 (0.7%) | 0.06 |
Number of aortocoronary grafts | 0.38 | ||
None | 90 (70%) | 278 (67.9%) | |
1 | 27 (19.3%) | 72 (17.6%) | |
2 | 9 (6.4%) | 38 (9.3%) | |
3 | 6 (4.3%) | 18 (4.4%) | |
4 or more | 0 (0%) | 3 (0.7%) | |
Cardiopulmonary bypass time | 95.7 ± 37.9 | 81.3 ± 34.9 | <0.001 |
Cross-clamping time | 77.2 ± 30.3 | 65.3 ± 29.1 | <0.001 |
Aortic root enlargement | 12 (2.9%) | 0 (0%) | 0.04 |
EuroSCORE II | 5.4 ± 5.8 | 4.5 ± 4.6 | 0.17 |
Logistic EuroSCORE | 12.9 ± 11.3 | 11.3 ± 9.3 | 0.21 |
Mortality and postoperative complications | |||
Pre-discharge mortality or <30 days | 24 (5.9%) | 9 (6.4%) | 0.47 |
Oro-tracheal intubation > 24 h | 57 (13.9%) | 23 (16.4%) | 0.49 |
Stroke | 11 (2.7%) | 4 (2.9%) | 1 |
Acute myocardial infarction | 6 (4.3%) | 32 (7.8%) | 0.18 |
New need of permanent pacemaker | 8 (2%) | 15 (10.7%) | 0.002 |
Supraventricular arrhythmia without effective cardioversion | 18 (12.9%) | 66 (16.1%) | 0.42 |
Peri-valvular regurgitation | <0.001 | ||
I | 8 (1.9%) | 6 (4.3%) | |
II | 2 (0.5%) | 5 (3.6%) | |
III | 1 (0.2%) | 3 (2.1%) | |
IV | 0 (0%) | 0 (0%) | |
Intra-valvular regurgitation | <0.001 | ||
I | 11 (2.7%) | 14 (10%) | |
II | 1 (0.2%) | 3 (2.1%) | |
III | 0 (0%) | 0 (0%) | |
IV | 0 (0%) | 0 (0%) |
Variables | Trifecta (n = 385) | Perceval (n = 131) |
---|---|---|
Number 19/S | n = 73 | n = 32 |
Prevalence of PPM | ||
No PPM | 54 (73.2%) | 16 (50%) |
Moderate PPM | 13 (17.8%) | 12 (37.5%) |
Severe PPM | 6 (8.2%) | 4 (12.5%) |
Mean gradient, mmHg | 14.4 ± 5.1 | 14.6 ± 4.6 |
EOA, cm2 | 1.6 ± 0.4 | 1.5 ± 0.3 |
IEOA, cm2/m2 | 0.9 ± 0.2 | 0.9 ± 0.2 |
Number 21/M | n = 140 | n = 52 |
Prevalence of PPM | ||
No PPM | 128 (91.4%) | 41 (78.9%) |
Moderate PPM | 10 (7.1%) | 11 (21.2%) |
Severe PPM | 2 (1.4%) | 0 (0%) |
Mean gradient, mmHg | 11.9 ± 4.8 | 12.4 ± 5.5 |
EOA, cm2 | 2 ± 0.3 | 1.7 ± 0.3 |
IEOA, cm2/m2 | 1.2 ± 0.2 | 1 ± 0.2 |
Number 23/L | n = 125 | n = 28 |
Prevalence of PPM | ||
No PPM | 115 (92%) | 24 (85.7%) |
Moderate PPM | 10 (8%) | 3 (10.7%) |
Severe PPM | 0 (0%) | 1 (3.6%) |
Mean gradient, mmHg | 9.4 ± 3.9 | 9.9 ± 3.8 |
EOA, cm2 | 2.3 ± 0.4 | 1.8 ± 0.3 |
IEOA, cm2/m2 | 1.2 ± 0.2 | 1 ± 0.2 |
Number 25–27/XL | n = 47 | n = 19 |
Prevalence of PPM | ||
No PPM | 47 (100%) | 17 (79.5%) |
Moderate PPM | 0 (0%) | 2 (10.5%) |
Severe PPM | 0 (0%) | 0 (0%) |
Mean gradient, mmHg | 6.7 ± 2.5 | 8.4 ± 2.9 |
EOA, cm2 | 2.5 ± 0.4 | 2.1 ± 0.2 |
IEOA, cm2/m2 | 1.4 ± 0.2 | 1.1 ± 0.2 |
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Hernandez-Vaquero, D.; Vigil-Escalera, C.; Persia, Y.; Morales, C.; Pascual, I.; Domínguez-Rodríguez, A.; Rodríguez-Caulo, E.; Carnero, M.; Díaz, R.; Avanzas, P.; et al. Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch. J. Clin. Med. 2020, 9, 2964. https://doi.org/10.3390/jcm9092964
Hernandez-Vaquero D, Vigil-Escalera C, Persia Y, Morales C, Pascual I, Domínguez-Rodríguez A, Rodríguez-Caulo E, Carnero M, Díaz R, Avanzas P, et al. Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch. Journal of Clinical Medicine. 2020; 9(9):2964. https://doi.org/10.3390/jcm9092964
Chicago/Turabian StyleHernandez-Vaquero, Daniel, Carlota Vigil-Escalera, Yvan Persia, Carlos Morales, Isaac Pascual, Alberto Domínguez-Rodríguez, Emiliano Rodríguez-Caulo, Manuel Carnero, Rocío Díaz, Pablo Avanzas, and et al. 2020. "Perceval or Trifecta to Prevent Patient–Prosthesis Mismatch" Journal of Clinical Medicine 9, no. 9: 2964. https://doi.org/10.3390/jcm9092964