What are the current results of sutureless valves in high-risk aortic valve disease patients?

Abstract

A best evidence topic was written according to a structured protocol. The question addressed was whether sutureless aortic valves have a clinical and haemodynamic benefit in high-risk patients with aortic valve disease. A total of 307 papers were found using the reported searches; of which, six represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the outcomes of sutureless aortic valve implantation in high-risk patients undergoing aortic valve replacement. Reported measures included mortality; post-operative complications namely stroke, renal failure, endocarditis and bleeding; valve deployment, cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times; echocardiographic assessment of paravalvular leaks (PVLs) and valve haemodynamics; and symptomatic functional class. Hospital mortality ranged between 3.1 and 12.5% and long-term mortality ranged between 3.1 and 10%. Incidence of PVL was found to be between 0.0 and 11%. Stroke was observed in 0.7%, renal failure in 3.1%, prosthetic valve endocarditis in 2.1-3.1% and major bleeding in 3.1%. The valve deployment time was 9-21 min, CPB time 35-111 min and ACC time 17-70 min. Short-term mean and peak valve gradients were in the ranges of 10-11 and 18-22 mmHg, respectively, reducing to 8-9 and 16.4-19 mmHg, respectively, at follow-up. Owing to the lack of comparative studies analysing the outcomes of sutureless and conventional aortic valves, we compared these results with the recently published PARTNER Trial (Transcatheter vs. Surgical Aortic-Valve Replacement in High-Risk Patients), and it can be shown that the outcomes of sutureless aortic valves compare favourably with conventional valves in terms of mortality, neurological deficit, renal failure and post-operative bleeding. However, there is increased incidence of endocarditis and PVLs, together with raised mean valve gradients, perhaps owing to the mechanical properties and deployment techniques of sutureless aortic valves.