ONE-YEAR FOLLOW-UP OF SUTURELESS AORTIC VALVE REPLACEMENT USING THE PERCEVAL S PROSTHESIS

Abstract

Sutureless aortic valve replacement (AVR) is an emerging alternative to standard AVR in elderly, high-risk surgical patients. Several published series have demonstrated good perioperative outcomes. However, there is little data in the literature on the durability of this technique and on the clincial follow-up of patients who undergo sutureless AVR. The purpose of this study was to report the one-year clinical and echocardiographic outcomes of patients undergoing sutureless AVR. Between June 2011 and March 2013, 108 consecutive patients underwent sutureless AVR with the Perceval S prosthesis. Patients were followed annually at our institution’s valve clinic. Mean follow-up was 14.1±5.7 months. Mean age was 79.2±4.7 years and 55(51%) patients were female. Mean Logistic EuroSCORE II was 7.0±8.6%. The approach used was a median sternotomy in 74(69%) patients, a ministernotomy in 12(11%) and right anterior parasternal minithoracotomy in 22(20%) patients. Concomitant procedures included CABG in 37 (34%) patients, mitral valve surgery in 9 (8%), septal myectomy in 7 (7%) and tricuspid valve plasty in 3 (3%). Eleven patients (10%) had undergone previous cardiac surgery. Mean aortic cross-clamp time was 40.1±12.3 minutes for isolated AVR and 61.9±21.5 minutes for combined procedures. Operative mortality was 4.6%. Twelve patients (11%) suffered from complete atrioventricular block. Postoperative permanent pacemaker implantation was performed in 23(21%) patients. Mean transaortic gradient was reduced from 45.1±16.6 mmHg preoperatively to 15.0±5.9 mmHg at discharge (p<.001). Indexed aortic effective orifice area was improved from 0.47±0.18 cm2/m2 preoperatively to 0.90±0.21 cm2/m2 at discharge (p<.001). Pre-discharge echocardiographic evaluation showed mild (1/4) paravalvular leak in 14(13%) patients. Among perioperative survivors, one-year survival was 92±3%. No patient underwent reoperation during the follow-up period. At last follow-up, all but one patient were in NYHA class I or II. At a mean echocardiographic follow-up of 14.1±4.6 months, mild (1/4) and moderate (2/4) paravalvular leaks were observed in 2 and 5 patients, respectively. Mean indexed left ventricular mass was 103±27 g/m2 compared to 107±27 g/m2 at baseline (p=.19). Left ventricular mass regression was observed in 57% of patients. Upon univariate analysis, indexed aortic effective orifice area at discharge was a significant predictor of left ventricular mass regression (OR 1.3 [1.0-1.6] per 0.10 cm2/m2; p=.05). Sutureless AVR yields good survival at one year considering the high baseline risk of this population. Paravalvular leak is a marginal occurrence. Left ventricular mass regression seems to be dependent on the complete relief of left ventricular outflow tract obstruction.