Sutureless Aortic Valve Replacement in Complex Procedures: What Is the Benefit?

Abstract

Objectives: Sutureless aortic valve replacement (AVR) has been associated with excellent hemodynamic and clinical outcomes, but less is known on the outcomes of the patients operated on for complex surgery. We aimed to evaluate the early outcomes and 1-year follow-up of patients undergoing AVR with a self expandable sutureless valve and concomitant procedures. Methods: Two European centers participated in the study, with a total number of self expandable aortic valve prosthesis implants equal to 682 (time frame May 2010 - May 2014). Of them, 168 (mean age 76.7 ± 6.4 years, female gender 93 (55.4%)) have been operated on for concomitant procedures.. Minimally invasive approach was chosen for 30 (17.9%) patients (14 ministernotomies and 16 right anterior minithoracotomies). 12 (7.1%), 45 (26.8%), 96 (57.1%) and 15 (8.9%) patients received 21 mm, 23 mm, 25 mm and 27 mm size prostheses, respectively. Common implantation technique was implemented in all the patients; coronary artery bypass grafting (if any) and mitral valve repair/replacement (if any) were performed prior to aortotomy and aortic valve replacement. Results: Overall surgical mortality was 7 (4.2%). Cardiopulmonary bypass time and aortic cross-clamp time were 136.3 ± 48 (median and interquartile range: 92 (71–114 minute)) and 94.3 ± 33 (74 (52–98)) min, respectively. Median assisted ventilation time was 10 (range 3–380) h. Revision for bleeding was necessary in 11 (6.5%) patients. 2 (1.2%) patients developed permanent neurological deficit following stroke. In 3 (1.8%) patients transient ischemic attack was observed. In 5 (3.0%) patients acute renal failure developed postoperatively. Permanent pacemaker implant due to advanced atrioventricular block was required in 16 (9.5%). 6/161 (3.7%) patients died during follow-up (mean duration 14 ± 11 months). Mean transprosthetic gradient averaged 13.6 ± 5.4 mm Hg. Conclusion: Good early outcomes, comparable to those of tissue valve prostheses, can be achieved in patients, undergoing sutureless AVR and associated procedures. Shortening the operative times, the self expandable sutureless prosthesis amplifies the armamentarium of aortic valve prostheses and represents a useful tool for associated and complex procedures.