Sutureless Aortic Valve Research Articles

Off-Label Sutureless Aortic Valve in the Failing Homograft

Homografts have been used in the aortic position as an alternative to xenograft or mechanical prostheses. With time, the leaflets and walls of the graft develop heavy calcification, making redo surgery hazardous. This study presented two patients who had successful sutureless bioprosthetic valve implantation into failing homografts, avoiding redo Bentall's procedure. It is believed that there has been one other report on the use of a sutureless aortic valve in this setting. The first patient is a 67-year-old male who underwent redo sternotomy, bioprosthetic aortic and mitral valve replacements and tricuspid annuloplasty. He initially underwent homograft aortic root, ascending aortic and hemiarch replacement in 1999 for a stenosed bicuspid aortic valve and aneurysmal aorta. He presented heart failure with pulmonary oedema. Transthoracic echocardiogram demonstrated a ruptured left coronary cusp, severe aortic, mitral, and tricuspid regurgitation, and pulmonary hypertension. Due to urgency and the extensive risk of a redo Bentall's procedure, he underwent a sutureless aortic valve implantation into the homograft. The patient was discharged home on postoperative day 10, after resolved delirium. Another 43-year-old male underwent homograft aortic root replacement in 1995 for bicuspid aortic valve and aortopathy. In 2018, he was diagnosed with severe aortic regurgitation secondary to perforated leaflets and redo surgery was planned with increased risk due to extensive calcification (“porcelain aorta”). After excision of the homograft leaflets, a large sutureless valve was inserted. The patient had an uncomplicated postoperative course. These two patients demonstrated that off-label use of the sutureless aortic valve in the failing homograft can be safely performed and offers an alternative strategy in management of these challenging patients.

Early Postoperative Outcomes for Aortic Valve Replacement Using Stented Versus Sutureless Valves Via a Full Sternotomy or Minimally Invasive Approach: A Network Meta-Analysis of Surgical Techniques

Purpose: In the era of transcatheter aortic valve replacement, new technologies such as sutureless prosthetic valves and improved access via minimally invasive incisions offer a reduction in surgical trauma for patients undergoing surgical aortic valve replacement. It remains unclear whether a reduction in cardiopulmonary bypass and aortic cross-clamp times, or avoiding complete sternotomy offer improved early postoperative outcomes. A network meta-analysis was performed to compare minimally invasive aortic valve replacement (MiAVR) with sutureless aortic valve replacement (SuAVR), and full sternotomy aortic valve replacement (FAVR).

Determining Sutureless Aortic Prosthesis Size With Echocardiography and Early Outcomes of Sutureless Aortic Valve Replacement

Determining Sutureless Aortic Prosthesis Size With Echocardiography and Early Outcomes of Sutureless Aortic Valve Replacement

Aortic Valve Infective Endocarditis With an Anomalous Left Main Coronary Artery: Sutureless Aortic Valve Implantation is a Safe Option

Aortic Valve Infective Endocarditis With an Anomalous Left Main Coronary Artery: Sutureless Aortic Valve Implantation is a Safe Option

Conduction disorders and impact on survival after sutureless aortic valve replacement compared to conventional stented bioprostheses.

Sutureless and rapid-deployment aortic valve prostheses are frequently used for the treatment of aortic stenosis. However, postoperative left bundle branch block (LBBB) and permanent pacemaker (PPM) implantation have emerged as frequent complications. The aim of this study was to compare the incidence of new-onset LBBB and PPM implantation after sutureless aortic valve replacement (sAVR) with stented bioprostheses, and the impact on postoperative survival. Patients undergoing isolated surgical aortic valve replacement (AVR) or concomitant AVR with coronary artery bypass surgery between January 2010 and July 2017 were included in the study. Two groups were defined: sAVR and conventional AVR (cAVR). The findings of preoperative electrocardiograms were compared with postoperative electrocardiogram findings for both groups. The incidence of new-onset LBBB and the requirement for PPM implantation were recorded. The effect of these conduction disorders on late survival was analysed. A total of 987 patients were analysed, consisting of 132 sAVR and 855 cAVR patients. The sAVR group had an increased incidence of new-onset LBBB compared to the cAVR group (16.7% vs 2.3%, P < 0.001). A significantly higher rate of postoperative PPM implantation was found for sAVR patients compared to cAVR (6.8% vs 1.6%, P = 0.001). The multivariate Cox analysis revealed that neither postoperative new-onset LBBB nor PPM implantation was associated with increased mortality (hazard ratio 1.73, 95% confidence interval 0.74-4.03, P = 0.204). sAVR is associated with an increased risk of new-onset LBBB and PPM requirement compared to cAVR. In this population, postoperative conduction disorders did not affect the mid-term survival.

Permanent pacemaker implantation and paravalvular leak rates following sutureless aortic valve operations.

Permanent pacemaker (PPM) implantation and paravalvular leak (PVL) rates after sutureless aortic valve replacement (SuAVR) vary widely. The aim of this meta-analysis was to examine the incidence of new PPM implantation and PVL after SuAVR. Studies evaluating PPM implantation and PVL rates after SuAVR were searched in Medline/PubMed, Ovid Journals, Clinicaltrials.gov, Cochrane central register of controlled trials and database. Studies with a sample size ≥10 were included in this analysis. Pooled proportions were calculated using both the fixed and random-effects models. The heterogeneity among studies was tested using I2 statistic. The study design was written in accordance with PRISMA guidelines. Thirty studies involving 3993 patients with a median follow-up of 12 months were included. The median age was 77 years and males constituted 50%. There was a history of stroke and coronary artery disease in 6% and 31% of the population. Pooled proportions demonstrate a cumulative postoperative PPM rate of 8.5% (95% confidence interval [CI] 7.6-9.5%, I2 = 68.8%) and the overall rate of any PVL was 4.2% (95%CI 3.4-5%, I2 = 76.1%) across all major SuAVR devices. The rate of severe PVL was only 0.4% (95%CI 0.2-0.7%, I2 = 0%) at discharge and 0.5% (95%CI 0.2-0.9%, I2 = 0%) at 12 months. In SuAVR prostheses implanted in this meta-analysis, the postoperative permanent pacemaker rate was higher (8.5%) than reported for non-SuAVR prosthesis. While the overall PVL rate was 4.2%, the incidence of severe PVL was only 0.4% at discharge and remained stable at 0.5% at 12 months.

RF59 PERCEVAL SUTURELESS AORTIC VALVE PROSTHESIS: A PRECIOUS DEVICE TO SIMPLIFY COMPLEX PROCEDURES

Abstract Background and aim: The main feature of sutureless aortic valve implantation is the speed of insertion, thus making implantation easier for the surgeon. As a result, cross clamp times and myocardial ischemia may be reduced. The combined procedures with CABG can be done with a short cross clamp time and cardiopulmonary bypass times. The aim of this study is to evaluate the effects of Percevall sutureless aortic valve prosthesis on surgical outcome in patients underwent combined procedures. Methods: We selected 36 consecutive patients who underwent Perceval implantation combined with coronary artery bypass and or other valve repair or replacement. Clinical, echocardiographic and in-hospital complications were obtained from chart review. Results: The mean age was 76.4 ± 9.8 (median 80) years old, 50% male. Eight of them were previous operated (Redo cardiac surgery22.2%), 3 treated with chronic kidney injury requiring dialysis (8.3%) and two had active endocarditis. Concomitant procedures included: coronary artery bypass (20 pts, 56%), mitral valve replacement or repair (11 pts, 31%), mitral and tricuspid repair/replacement (5 pts, 5%), tricuspid valve repair (1pt,3%) and mitral valve replacement associated to coronary artery bypass (2 pts, 5%). Patient operative risk, as estimated by logistic European System for Cardiac Operative Risk Evaluation, was 13.4 ± 12.8. Conclusions: Perceval sutureless aortic prosthesis facilitates reduced aortic cross-clamp and cardiopulmonary bypass times particularly in patients undergoing concomitant procedures allowing promising outcomes especially in high risk patients.

Mid-term follow-up after suture-less aortic heart valve implantation.

Aortic stenosis (AS) is the most common valve disease in the adult population and its prevalence increases with age. Unfortunately, older age and comorbidities significantly increase mortality, operative risk and worsen prognosis. In recent years, sutureless bioprosthesis [sutureless-aortic valve replacement (SU-AVR)] has become an alternative to standard AVR or TAVI in high-risk patients. Compared to standard AVR, the advantages of SU-AVR include shorter valve implantation, shorter aortic cross clamp (ACC) and cardiopulmonary bypass (CPB) times and higher valve EOA with more favorable hemodynamic parameters. Good early clinical and hemodynamic outcomes have been reported in several studies. However, although early SU-AVR results reported in the literature are encouraging, there are few results of long term follow-up. The aim of this study is to present long term echocardiographic hemodynamic outcomes of the Enable sutureless bioprosthesis. The first human implantation of the Enable sutureless bioprosthesis was performed on the 13th January, 2005 by the authors of this manuscript. From that time until July 2008, 25 patients underwent isolated SU-AVR implantation. The median preoperative logistic EuroSCORE was 1.92±0.17 [standard deviation (SD)] and the STS score was 2.96±2.73. Preoperatively, 65.4% of patients were in NYHA class III or IV, the peak/mean gradient transaortic gradient was 84.6/52.1 mmHg. After the SU-AVR procedure, the average peak/mean aortic gradients were respectively: 12.9/7.1 mmHg at the intraoperative time; 18.1/9.5 mmHg at 3-6 months; 18.3/9.6 mmHg at 11-14 months; 16.9/9.3 mmHg at 2 years; 15.3/8 mmHg at 3 years; 13.4/7.1 mmHg at 4 years; 16.7/8.9 mmHg at 5 years follow-up. Other hemodynamic echocardiographic parameters such as LVOT diameter, LVOT peak velocity, LVOT TVI, valve peak velocity and valve TVI were stable during the follow-up period. In summary, sutureless bioprostheses are safe and effective treatments for valve stenosis with excellent outcomes and hemodynamic profile which remained stable during the follow-up period. The peak and mean gradients were 16.7 and 8.9 mmHg, respectively, over a 5-year follow-up period.

Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk.

BackgroundMeta-analyses of studies comparing transcatheter aortic valve implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show differing effectiveness and safety profiles. The approaches also differ in their surgical cost (including operating room and device).ObjectiveThe objective of this study was to assess the incremental cost-utility of SU-AVR vs TAVIs for the treatment of intermediate- to high-risk patients in the US, Germany, France, Italy, UK, and Australia.MethodsA patient-level simulation compares in-hospital pathways of patients undergoing SU-AVR or TAVIs; later, patient history is modeled at the cohort level. Hospital outcomes for TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates in a recent meta-analysis on 1,462 patients. After discharge, survival depends on the development of paravalvular leak and the need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted.ResultsDue to lower in-hospital (4.1% vs 7.0%) and overall mortality, patients treated with SU-AVR are expected to live an average of 1.25 years more compared with those undergoing TAVIs, with a mean gain of 1.14 quality-adjusted life-years. Both in-hospital and long-term costs were lower for SU-AVR than for TAVIs with total savings ranging from $4,158 (France) to $20,930 (US).ConclusionSU-AVR results dominant when compared to TAVIs in intermediate- to high-risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for the quality of life.

EP37 TECHNICAL PRECAUTIONS TO REDUCE THE PACEMAKER RATE AFTER SUTURELESS AORTIC VALVE REPLACEMENT: DID WE FIND THE KEY?

Background and Aim: The aim of this study is to evaluate the patients who have required a pacemaker implantation after a sutureless aortic valve implant, evaluating their clinical history and preoperative risk factors, the peri- and postoperative events that led to pacemaker implantation including “timing” of block and pacemaker implantation and the pacemaker-dependence at follow-up. Methods: The 512 patients who were discharged from our department after implantation of Perceval and implantation of the definitive pacemaker were re-contacted for clinical follow-up, echocardiography and for control of pacemaker function. Results: 39 patients (7.6%) required new pacemaker implantation due to complete atrioventricular block. Preoperative presence RBBB (pacemaker vs no-pacemaker patients 33 vs 4.8%;P &lt; 0.001) was identified as independent predictors of postoperative conduction disorders, also on multivariate analysis (odds ratio 11.3—C-statistic 0.74,CI 0.672–0.801; P = 0.0002). 21 patients (54%) were pace independent at follow up. In the “pacemaker patients group” no difference were recoded between pace-dependent and pace-independent at follow up (Table 1). Over the years, with the change in implant technique, the pacemaker implantation rate has decreased significantly: 12.2% to 5.5%, p = 0.04. Conclusions: Our study shows that the protective techniques for pacemaker implantation are effective and that learning curve can play a role in this rate. We are not able to find a difference between the “dependent” and “independent” pacemaker patients at follow up but we believe that the timing of implantation as well as the type of BAV onset can be prognostic on the recovery of the rhythm at follow up.

Prospective US investigational device exemption trial of a sutureless aortic bioprosthesis: One-year outcomes

ObjectivesWe performed a prospective, single-arm clinical trial approved under a Food and Drug Administration Investigational Device Exemption to assess safety and efficacy of Perceval, a sutureless bovine pericardial aortic valve representing the initial US experience. MethodsFrom June 2013 to January 2015, 300 patients (mean age 76.7 ± 7.7 years, 54.3% men, 37.3% ≥80 years, median Society of Thoracic Surgeons Predicted Risk of Mortality 2.8%), underwent Perceval valve implantation at 18 centers across the United States. Twenty patients (6.7%) had a bicuspid aortic valve and 5 (1.7%) patients had previous aortic valve replacement. A minimally invasive approach was used in 80 (26.7%) and concomitant procedures were performed in 113 (37.8%) patients. ResultsTwo hundred eighty-nine patients (96.3%) were successfully implanted. Operative mortality (≤30 days) was 1.3% (n = 4) (observed to expected ratio of 0.40). One-year results included all-cause mortality in 5.2% (n = 15), stroke in 1% (n = 3), and endocarditis in 1.7% (n = 5). New permanent periprocedural pacemaker rate was 10.7% (n = 30/281); 2.5% (n = 7/281) resulted from third-degree atrioventricular block. One-year valve-related reoperation was 2.1% (n = 6). At 1-year follow-up, 98% of patients were in New York Heart Association class I/II, left ventricular mass index decreased from 103.5 ± 30.1 g/m2 at discharge to 95.8 ± 27.1 g/m2 (P = .001), and 3 (1.3%) moderate paravalvular leaks were identified. Health-related quality of life score increased from 62.7 ± 21.8 before surgery to 85.5 ± 17.8 at 1 year (P < .001). ConclusionsThese results confirm the safety and effectiveness of the Perceval sutureless aortic valve replacement in study patients with lower mortality than expected from a risk prediction model. Persistent hemodynamic benefit and improvement in quality of life at 1 year support the importance of this device in the management of aortic valve disease.

Sutureless Valve Replacement Through a Right Anterior Mini-thoracotomy in Elderly Patients With Stenotic Bicuspid Aortic Valve

Several indications for sutureless aortic valve replacement (SU-AVR) have been a matter of debate. We evaluated our experience with Perceval-S (LivaNova group, Saluggia, Italy) SU-AVR in patients with severe aortic stenosis (AS) involving bicuspid aortic valve (BAV), even though presence of BAV is still considered to be a contraindication for sutureless valves. From January 2013 through March 2018, 13 patients with severe AS involving BAV underwent SU-AVR with the Perceval-S (LivaNova group, Saluggia, Italy) prosthesis in a single center. Preoperative evaluation included coronary catheterization and multisliced computerized tomography was performed in all patients. Three-dimensional transthoracic echocardiography was used to evaluate for obtaining the anatomy and phenotype of BAV. Minimally invasive approach through right anterior thoracotomy from third intercostal space was performed for all patients. The mean age was 72.8 ± 2.26 years ranging from 70 to 77, and 53.8% (n = 7) were male. The mean aortic valve gradient decreased from 46.4 ± 13.8 to 13.6 ± 4.4 mmHg postoperatively. The mean aortic valve area increased from 0.69 ± 0.22 to 1.81 ± 0.38 cm2. There was no in-hospital mortality. One patient (7.6%) had third-degree atrioventricular block requiring permanent pacemaker implantation. Mean follow-up was 15.1 ± 6.3 months (maximum 2 years). No major paravalvular leakage or valve migration occurred postoperatively. This study shows that SU-AVR is a technically feasible and safe procedure in patients with severe AS and BAV with acceptable good surgical outcomes. Presence of BAV in AS should not be considered a contraindication to Perceval-S prosthesis (LivaNova group, Saluggia, Italy).

PMD113 - COST–UTILITY OF SURGICAL SUTURELESS BIOPROSTHESES VS. TAVI IN AORTIC VALVE REPLACEMENT FOR PATIENTS AT INTERMEDIATE AND HIGH SURGICAL RISK

Transcatheter aortic valve implantations (TAVI) and sutureless aortic valve replacement (SU-AVR) have been compared in several clinical trials or meta-analyses, indicating differing effectiveness and safety profiles. The approaches also differ in their surgical cost (operating room and device). These results could lead to lower costs and increase in quality of life with SU-AVR. Aim of this work is to assess the incremental cost-utility of SU-AVR versus TAVI for the treatment of intermediate-to-high risk patients in US, Germany, France, Italy, UK and Australia. A patient-level discrete event simulation was developed to compare in-hospital pathways of patients undergoing SU-AVR or TAVI; after discharge, lifetime evolution was modeled using a cohort Markov model. Hospital outcomes for TAVI reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates from Meco et al. meta-analysis. After discharge, survival depends on the development of para-valvular leak and need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted. All costs were expressed as 2017 US dollars. In-hospital mortality for SU-AVR resulted lower than TAVI (4.1% vs 7.0%) with an analogous improvement in the lifetime survival (5.51 vs 4.26 LYs); patients with SU-AVR lived 1.25 years more than patients undergoing TAVI (IQR 1.03-1.44) with a mean gain of 1.14 QALYs (IQR 0.98-1.31). Both hospital and long-term costs resulted lower for SU-AVR than TAVI with total savings ranging from about $ 4,160, for France, to almost $ 21,000, for US. SU-AVR results dominant when compared to TAVI in intermediate-to-high risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for quality of life.

Snugger method - The Oldenburg modification of perceval implantation technique.

We present a modified implantation technique of the Perceval® sutureless aortic valve (LivaNova, London, United Kingdom) that involves the usage of snuggers for the guiding sutures during valve deployment. Both limbs of each guiding suture are pulled through an elastic tube, which is fixed with a Pean clamp, which tightens the sutures and fixes the prosthesis to the aortic annulus during valve deployment. This method proved safe and useful in over 120 cases. Valve implantation was facilitated and the need for manipulation by the assistant or the nurse was eliminated.

TCT-671 A Systematic Review and Meta-Analysis of Permanent Pacemaker Implantation and Paravalvular Leak Rates after Sutureless Aortic Valve Operations

TCT-671 A Systematic Review and Meta-Analysis of Permanent Pacemaker Implantation and Paravalvular Leak Rates after Sutureless Aortic Valve Operations

Thrombocytopenia in Moderate- to High-Risk Sutureless Aortic Valve Replacement.

BackgroundThis study aimed to compare preliminary data on the outcomes of sutureless aortic valve replacement (SU-AVR) with those of aortic valve replacement (AVR).MethodsWe conducted a retrospective study of SU-AVR in moderate- to high-risk patients from 2013 to 2016. Matching was performed at a 1:1 ratio using the Society of Thoracic Surgeons predicted risk of mortality score with sex and age. The primary outcome was 30-day mortality. The secondary outcomes were operative outcomes and complications.ResultsA total of 277 patients were studied. Ten patients (50% males; median age, 81.5 years) underwent SU-AVR. Postoperative echocardiography showed impressive outcomes in the SU-AVR group. The 30-day mortality was 10% in both groups. In our study, the patients in the SU-AVR group developed postoperative thrombocytopenia. Platelet counts decreased from 225×103/μL preoperatively to 94.5, 54.5, and 50.1×103/μL on postoperative days 1, 2, and 3, respectively, showing significant differences compared with the AVR group (p=0.04, p=0.16, and p=0.20, respectively). The median amount of platelet transfusion was higher in the AVR group (12.5 vs. 0 units, p=0.052).ConclusionThere was no difference in the 30-day mortality of moderate- to high-risk patients depending on whether they underwent SU-AVR or AVR. Although SU-AVR is associated with favorable cardiopulmonary bypass and cross-clamp times, it may be associated with postoperative thrombocytopenia.

Early Outcomes of Sutureless Aortic Valve Replacement With the Perceval S Bioprosthesis

Sutureless aortic valve replacement (SU-AVR) offers an alternative to traditional aortic valve replacement (AVR) and is becoming widely performed in many hospitals. The aim of the current study was to evaluate the early experience in SU-AVR with the Perceval S bioprosthesis at Monash Medical Centre. Fifty-two (52) patients who underwent SU-AVR were retrospectively analysed (mean age: 74.8±6.5years). Data regarding preoperative and operative details, hospital stay, postoperative outcomes within 30days after surgery, re-admissions and longer term echocardiographic data were collected from the relevant hospital databases. In isolated SU-AVR, the mean aortic cross-clamp and cardiopulmonary bypass times were 48.8 and 67.8minutes, respectively. There were no deaths within 30days after surgery. Rhythm disturbances developed in 46.2% of patients, with atrial fibrillation (32.7%) and heart block (9.6%) being most common. Mean and peak transaortic gradients reduced from 46.2 and 77.9mmHg preoperatively, to 10.7 and 19.7mmHg at 12 months postoperatively, respectively. The absence of early mortality and the satisfactory clinical and haemodynamic results demonstrated the overall safety and efficacy of the Perceval S valve. Although sutureless valves seem to be a promising alternative to traditional sutured valves, the high rate of new postoperative rhythm disturbances, particularly heart block, is potentially a concern with SU-AVR.

The flutter-by effect: a comprehensive study of the fluttering cusps of the Perceval heart valve prosthesis.

Sutureless aortic valve prostheses are gaining popularity due to the substantial reduction in cross-clamp time. In this study, we report our observations on the cusp-fluttering phenomenon of the Perceval bioprosthesis (LivaNova, London, UK) using a combination of technical and medical perspectives. Between August 2014 and December 2016, a total of 108 patients (69% women) with a mean age of 78 years had aortic valve replacement using the Perceval bioprosthesis (34 combined procedures). All patients underwent transoesophageal echocardiography (TOE) intraoperatively. TOE was performed postoperatively to detect paravalvular leakage and to measure gradients, acceleration time, Doppler velocity indices (Vmax and LVOT/Vmax AV) and effective orifice area indices. In addition, a TOE examination was performed in 21 patients postoperatively. Data were collected retrospectively from our hospital database. The retrospective evaluation of the intraoperative TOE examinations revealed consistent fluttering in all patients with the Perceval bioprosthesis. The echocardiographic postoperative measurements showed a mean effective orifice area index of 0.91 ± 0.12 cm2/m2. The overall mean pressure and peak pressure gradients were in a higher range (13.5 ± 5.1 mmHg and 25.5 ± 8.6 mmHg, respectively), whereas acceleration time (62.8 ± 16.4 ms) and Doppler velocity indices (0.43 ± 0.11) were within the normal range according to the American Society of Echocardiography or european association of echocardiography (EAE) guidelines. The 2-dimensional TOE in Motion Mode (M-Mode) that was performed in patients with elevated lactate dehydrogenase (LDH) levels revealed remarkable fluttering of the cusps of the Perceval bioprosthesis. In our study cohort, we observed the fluttering phenomenon in all patients who received the Perceval bioprosthesis, which was correlated with elevated LDH levels and higher pressure gradients.

Sutureless aortic valve replacement with concomitant valvular surgery

ObjectivesSutureless aortic valve replacement (SU-AVR) is an alternative technique to standard aortic valve replacement. We evaluated our experience with the Perceval SU-AVR with concomitant mitral valve surgery, with or without tricuspid valve surgery, and aimed to discuss the technical considerations. MethodsFrom January 2013 through June 2016, 30 patients with concomitant severe mitral valve disease, with or without tricuspid valve disease, underwent SU-AVR with the Perceval prosthesis in a single center. ResultsThe mean age was 73.0 ± 6.6 years, ranging from 63 to 86 years, and 60% (n = 18) were male. Mean logistic EuroScore of the study cohort was 9.8 ± 4.6. Concomitant procedures consisted of mitral valve repair (n = 8, 26.6%), mitral valve replacement (n = 22, 73.3%), tricuspid valve repair (n = 18, 60%), tricuspid valve replacement (n = 2, 6.6%), and cryoablation for atrial fibrillation (n = 21, 70%). Median prosthesis size was 25 mm (large size). At 1 year, there were 2 deaths from noncardiac causes. One patient (3.3%) had third-degree atrioventricular block requiring permanent pacemaker implantation. Three patients (10%) had intraoperative supra-annular malpositioning of the aortic prosthesis, which was safely removed and reimplanted in all cases. Mean follow-up was 18 ± 4.5 for months (maximum 3 years). During the postoperative period, sinus rhythm restoration rate in patients who underwent the cryo-maze procedure was 76.1% (n = 16) at discharge. There was no structural valve deterioration or migration of the prosthesis at follow-up. ConclusionsPerceval SU-AVR is a technically feasible and safe procedure in patients with severe aortic stenosis with good results even in the presence of multivalvular disease and atrial fibrillation surgery.

Early Clinical Experience with Sutureless Aortic Valve Replacement for Severe Aortic Stenosis.

BackgroundSutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment for patients with symptomatic severe aortic stenosis (AS). The aim of this study was to evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety.MethodsFrom December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was 18.1±8.6 months.ResultsThe mean age of the patients was 77.1±5.8 years and their mean Society of Thoracic Surgeons score was 9.2±17.7. The mean cardiopulmonary bypass and aortic cross-clamp times were 94.5±37.3 minutes and 54.9±12.5 minutes, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, 13.9±8.6 mm Hg and peak, 27.2±15.0 mm Hg) at a mean of 9.9±4.2 months. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was 83.3%±10.8%.ConclusionOur initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.