Sutureless Aortic Valve Implantation: Single Surgeon Experience

Abstract

Objectives: Surgical aortic valve replacement (AVR) is the treatment of choice in patients with severe symptomatic aortic valve stenosis. In recent years, the number of high-risk patients being referred for surgical AVR has increased. A considerable proportion of these patients are deemed operable despite the high risk. In order to modify the risk predominantly associated with duration of cardiopulmonary bypass (CBP) and cross clamp (ACC) time, sutureless aortic valve technology have been developed. They bear the potential of easy implantation, reduced ACC, CPB time. We herein show our experience, focussing on ACC time, early mortality, morbidity, and valve haemodynamics. Methods: A sutureless valve was implanted following sternotomy, extracorporeal circulation, aortic cross clamping, cardioplegic arrest, and removal of the native valve. Optimal annular sealing was obtained with brief low-pressure balloon dilation without suturing. Between January 2012 and August 2015, sutureless aortic valve was used in 27 patients (mean age, 75.1 ± 5.3 years; mean additive EuroSCORE, 11.9 ± 4.1) with or without concomitant surgery. Haemodynamic parameters and clinical outcome were obtained retrospectively. Results: The patients received size S (10),M(13),L(3),XL(1) prosthesis, either as isolated(13) or combined procedures(14). Mean logistic euroSCORE risk evaluation was 33.1 ± 27.1%, mean aortic cross-clamp time was 51.1 ± 28.4 minutes (31.6 ± 9.0 minutes for isolated procedures). Mean implantation time was 6,8 ± 2.8 minutes. Haemodynamics at discharge showed good function of all sutureless valves with low transvalvular pressure gradients (mean 10.8 ± 4.1 mmHg). Thirty-day early mortality was 18.5% (5 patients). Conclusions: Sutureless valves are efficient and well-functioning devices that offer the advantage of considerable shortening of the duration of aortic cross clamping. Adequate follow-up studies are required to evaluate long-term outcome.