Abstract
Introduction:The recently introduced sutureless prostheses for aortic valve replacement allow short cross-clamp and CPB times with good clinical and haemodynamic performances. It is arguable that these factors can positively impact on post-operative morbidity and mortality, in particular in those patients with a medium- high risk profile. This study shows the mid-term results of a single center experience in patients undergoing AVR. with the Perceval sutureless bioprosthesis (Sorin Group, Saluggia, Italy) Methods:One hundred patients (64 female; mean age 78.2±4.7 years) with aortic valve stenosis (mean gradient of 51.3±14,2 mmHg) underwent aortic valve implantation with the sutureless Perceval bioprosthesis. High-thoracic epidural analgesia was used in 31 patients (31%). Associated CABG surgery was performed in 29 patients (29,%). The mean logistic EuroSCORE was 14.9±9.4% and the STS score was 3,3±1,7. Results:Thirty-day mortality was 2% (n=2). Mean CPB and cross-clamp times for isolated AVR were 38,1±18,6 and 24,2±9,8 minutes respectively. Perioperative echocardiography revealed significant paravalvular leakage in three patients (3%). Postoperative mean trans-valvular gradient was 13.6±5.2 mmHg. AV block requiring PM implantation occurred in 2 patients (2%). No thrombosis and no post-operative strokes were observed. At a mean follow-up of 13±6.7 months, no significant paravalvular leakage or valvular regurgitation was observed, and no migration or dislodgement of the prosthesis occurred. Conclusions:This study shows that sutureless implantation of the Perceval aortic valve bioprosthesis provides a simple and reproducible alternative for standard AVR and TAVR in medium-high risk patients eligible for AVR. The use of this self-anchoring valve was also associated in our patients with absence of embolic events and a very low incidence of AV blocks requiring PM implantation. These findings encourage the use of this valve in a broader spectrum of patients A control randomized trial is needed to confirm these promising findings.
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