The sutureless aortic valve: a story of continuing improvements.

Abstract

In light of all evolutions in transcatheter treatment of aortic valve stenosis, also the world of surgical aortic valve replacement (AVR) has to keep evolving, with improvements in outcome for the patient as the most important objective. One of the possible ways to facilitate surgery and improve the overall result is to make the surgical procedure faster, easier and less invasive. Sutureless valve technology was introduced in surgical AVR to reach these goals [1]. The fact that we are able now to implant a tissue valve without any suture saves time and avoids unneeded manipulation in the aortic root. A quick implantation makes cross-clamp time, cardiopulmonary bypass time and overall procedure time significantly shorter. Some still argue whether this is relevant in a straightforward case of isolated valve replacement. But in many patients, like in more complex cases, more fragile patients, in minimal access surgery and in combined cases (CABG, multiple valves, etc.), taking off 20–30 min in cross-clamp and overall procedure time, can only be beneficial to the patient. It also opens doors to enhanced recovery and fast-track protocols. Next to the speed of implantation, the sutureless valve technology like Perceval also allows to position a valve with only minimal manipulation in the aorta. The absence of any need for stitching and knotting does not only provide an elegant bail-out scenario in complex cases but also—much more importantly—significantly facilitates minimal access surgery in single AVR. And still, the surgical field still needs a big push towards minimally invasive procedures for isolated AVR.