Abstract
Background: Elderly women undergoing aortic valve surgery are at high risk to develop patient-prosthesis mismatch (PPM) due to their small body size and cardiac structures; sutureless valves can overcome this problem. Aim: this retrospective study aims to compare sutureless valves with stented bioprosthesis in terms of (PPM) occurrence. Methods: From July 2001 to September 2017, 442 female patients received 280 sutured bioprosthesis and 162 sutureless bioprosthesis in the same center. Projected effective orifice arean was used to calculate the indexed effective orifice area (iEOA). A 1:1 propensity matching model based on patients’ BSA yield 162 comparable pairs. Results: sutureless valve exhibited lower CPB time and cross-clamp time (sutured vs. suturelss: 106.7 ± 42.0 min vs 92.6 ± 29.1 min; 71.9 ± 28.8 min vs 58.4 ± 19.9 min; p < 0.001), less transfusion rate (sutured vs. sutureless: 26% vs 14%; p = 0.014), lower delirium (sutured vs. sutureless: 11% vs 9%) and higher EOA and iEOA (sutured vs. suturelss: 1.716 ± 0.313 cm2 vs 2.527 ± 0.324 cm2; 1.016 ± 0.20 cm2/m2 vs. 1.495 ± 0.221 cm2/m2; p > 0.001). At follow-up, sutureless valves had lower mean gradient (sutured vs suturelss: 15.96 ± 8.33 mmHg vs 12.38 ± 5.10mmHg; p = 0.049). Conclusions: in our series, sutureless valves allowed expedite surgery, lower incidence of post-operative delirium and less hours of mechanical ventilation; hospital stay and mortality did not differed. Sutureless valves are associated with no PPM and lower mean gradients at follow-up. When anatomically indicated, sutureless valves should be the prosthesis of choice in elderly women.
Published Version
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