A new technique in sutureless aortic valve replacement–preliminary results

Abstract

Introduction: The Arbor-Trilogy-aortic-valve presents a new concept in aortic valve replacement (AVR). This bovine pericardial valve consists of a flexible, stand alone gasket which is similar to an annuloplasty ring and a bovine pericardial valve (crown). Because of the use of Tissue-Retention-Elements deployed with a rapid fire delivary tool of fixing the gasket to the annulus there is no need for suture. The valve crown is mounted onto the gasket using a guiding and locking mechanism. After implantation the valve leaflets open into the sinuses thereby presenting a large orifice area and hence a minimal transvalvular gradient. Presented are the early results of a feasibility study performed in our clinic. Methods: From November 2006 to May 2007 four patients received an AVR using the Arbor-Trilogy-aortic-valve. All presented with a severe aortic stenosis (mean gradient 69±24mmHg; mean orifice area 0,5±0,05cm2). Results: No perioperative deaths. Valve implantation took 22±7min in the first 2 patients and 10±4min in the next patients. All received a 23mm valve and had an uneventful postoperative course. Three months echocardiography showed no hemodynamic relevant aortic regurgitation in all patients, the mean gradient was 7,7±2,6mmHg, the effective orifice area was 1,8±0,3cm2. Conclusion: Although these four patients present our earliest experience with this valve it shows the feasibility of the technique and the excellent hemodynamic performance of the valve. We hope that these results will be further emphasized by our ongoing experience and that the improved hemodynamics will have a positive impact on valve longevity and longterm patient outcome.