Sutureless in Bicuspid Valves: Are There No More Limits?

Abstract

The use of sutureless prostheses for aortic valve replacement is widely practiced in many cardiac surgery centers with some known limits in the indication for implantation such as pure aortic valve insufficiency and bicuspid type “0”. On this last aspect, however, the debate is still open, given not only some sporadic implants that went well and badly, 1 Santarpino G. Pfeiffer S. Fischlein T. Perceval sutureless valve implantation in a patient with bicuspid aortic valve. Int J Cardiol. 2012; 157: e21-e22 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar ,2 Chiariello G.A. Villa E. Messina A. Troise G. Dislocation of a Perceval sutureless prosthesis after type I bicuspid aortic valve replacement. J Thorac Cardiovasc Surg. 2018; 156: e87-e89 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar but also multicenter experiences with hundreds of bicuspid patients—mainly Sievers type 1—who received a sutureless prosthesis. 3 Miceli A. Berretta P. Fiore A. et al. Sutureless and rapid deployment implantation in bicuspid aortic valve: results from the sutureless and rapid-deployment aortic valve replacement international registry. Ann Cardiothorac Surg. 2020; 9: 298-304 Crossref PubMed Google Scholar Modified Implant Technique of Perceval Sutureless Valve in Congenital Type 0 Bicuspid Valve StenosisThe Annals of Thoracic SurgeryVol. 111Issue 5PreviewThe Perceval sutureless valve has gained in popularity for treating degenerative aortic valve stenosis but not for congenital type 0 bicuspid aortic valve owing to anatomic challenges. We modified implant techniques following the four principles of ECHO—an acronym for elasticity, circularity, height, and orientation—to prevent paravalvular leakage and malposition. Full-Text PDF Not Every Aortic Stenosis Should Have Transcatheter Aortic Valve Implantation FirstThe Annals of Thoracic SurgeryVol. 113Issue 2PreviewWe appreciate the opportunity to respond to the comments submitted by Dr Santarpino and colleagues1 regarding our article in The Annals of Thoracic Surgery on the role of sutureless technique in bicuspid aortic valve (BAV).2 Because of increasing experience and the refinement of devices, treatment of degenerative aortic stenosis is dominated by transcatheter aortic valve implantation regardless of surgical risks as long as the anatomy fits.3,4 The debate over treatment options for young and low-risk patients with BAV will be ongoing, and surgeons should not step down just because of the need for cardiopulmonary bypass and an access wound. Full-Text PDF