Perceval sutureless bioprosthesis versus Trifecta sutured bioprosthesis for aortic valve replacement: immediate results of the Perfecta study

introduction: the perceval sutureless biological prosthesis for aortic valve replacement has been introduced with the rationale for shortening surgical, extracorporeal circulation and aortic cross-clamping times, in order to reduce postoperative complications. aim: to evaluate early hemodynamic performance and immediate outcomes of implantation of the perceval sutureless bioprosthesis in comparison with the St. Jude trifecta sutured bioprosthesis for aortic valve replacement (Perfecta study). material and methods: between december 2014 and June 2023, 281 patients underwent St. Jude Trifecta implantation (n = 220, mean age: 75.2 ±6.5 years) and Perceval implantation, when indicated (n = 61, mean age: 77.9 ±5.1 years). concomitant CABG was performed in 73 (33%) and in 27 (44%) patients, respectively. results: extracorporeal circulation and cross-clamp times were significantly shorter in perceval patients in all aortic valve replacements (61 ±23 and 49 ±18 minutes vs. 96 ±36 and 67 ±21 minutes), and in isolated procedures (54 ±10 and 43 ±8 minutes vs. 84 ±28 and 66 ±21 minutes) (p < 0.0001, for all comparisons). operative mortality was absent and 2.7%, respectively (p = 0.2). postoperatively, low output cardiac syndrome (0% vs. 4.5%) and total rate of major cardiac and non-cardiac related complications (6.6% vs. 18.6%) were significantly lower in perceval patients (p = 0.01). echocardiography at discharge in comparison with preoperatively showed a relevant and similar decrease of mean and peak trans-aortic valve gradients for the trifecta prosthesis (11.6 ±4.3 vs. 50 ±15.2 mm Hg; 21.6 ±7.3 vs. 78.8 ±24 mm Hg) and for the perceval prosthesis (12.6 ±4.8 vs. 52 ±12.5 mm Hg; 22.6 ±7.9 vs. 77.8 ±16 mm Hg) (p < 0.00001, for all comparisons). Better global cardiac function was observed in perceval patients. concomitant multi-vessel and left main coronary artery disease (p = 0.046; HR = 4.6) and chronic pulmonary disease (p = 0.006; HR = 5.6) were detected as independent predictors of death and postoperative major complications. conclusions: early hemodynamic performance appears to be satisfactory with the use of trifecta sutured and perceval sutureless bioprostheses. perceval implantation allows reduction of surgical times, better preservation of myocardial contractile function and, consequently, reduction of the risk of postoperative complications

Perforation of Left Ventricular wall and Ipsilateral Pleura by a Right Ventricular Pacemaker lead: Case Report

Introduction: Malposition of pacemaker lead is uncommon event and it usually regard the right ventricle. In rare cases, the perforation can involve the left ventricle and this is a potentially life-threatening complication. Case presentation: We described a case of both septum and LV free wall perforation by an RV pacemaker lead in an 84-year-old woman. Perforation also resulted in left pneumothorax and she became symptomatic. She also had pericardial effusion, so she underwent cardiac surgery to repair the bleeding lesion. As the swab for Covid-Sars 2 was positive, we had to wait for the negativization for the replacement of the ventricular lead. Conclusions: early identification is mandatory to prevent this complication and transvenous lead extraction with cardiac surgery backup should be considered