Sutureless Prosthesis Research Articles

Pacemaker need after sutureless aortic valve replacement: the role of the learning curve.

Aortic valve replacement (AVR) using sutureless prosthesis is a reasonable alternative in those patients with aortic stenosis who would benefit from reduced cross clamp time, such as elderly and high-risk patients. Actually, excellent performances have been demonstrated in hemodynamic outcomes and safety, but some questions remain open regarding long-term durability and the need for postoperative pacemaker implantation. Between January 2014 and August 2019, all 436 patients [male 40.6%, median age 78 years interquartile range (73-82)] treated with sutureless AVR with a Perceval prosthesis were included in our analysis. The univariate logistic regression showed previous aortic valve surgery [P = 0.028; odds ratio (OR) 3.248], dialysis (P = 0.036; OR 6.435), renal insufficiency (P = 0.021; OR 2.75), EuroSCORE II (P = 0.016; OR 1.051) and year of operation (P < 0.01; OR 0.658) as factors associated with the development of atrioventricular type II or type III block or junctional block requiring pacemaker implantation. The overall incidence of pacemaker implantation after sutureless AVR was 7.1% in the current study, but it dropped to 3.8 and 4.7%, respectively, in 2018 and 2019. The Perceval aortic valve is associated with encouraging postoperative results. The incidence of pacemaker implantation is strictly linked to the surgeons' experience, decreasing year by year after an adequate sizing, reaching a percentage comparable with sutured valve.

History, development and clinical perspectives of sutureless and rapid deployment surgical aortic valve replacement.

Degenerative aortic stenosis is the most frequent valvular heart disease in industrialized countries. Conservative treatment may beneficially influence symptoms but is never successful. Surgical aortic valve replacement (SAVR) was the only recognized treatment option to provide substantially prolonged survival until 2008. Operative mortality of isolated SAVR has been reported as low as 0.5% to 1% in experienced institutions, while long-term survival is close to that observed in a control healthy population of similar age. A multitude of studies have demonstrated the beneficial effects of SAVR with regard to improvement in quality of life and physical performance in the majority of symptomatic patients. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as an equal treatment modality, first in patients with high surgical risk and more recently in patients with intermediate and low surgical risk. Paravalvular regurgitation and the higher rate of pacemaker implantation remain points of consideration. Additionally, the long-term durability of TAVI devices and occurrence of stroke late after TAVI require additional analyses. Sutureless (SU-SAVR) and rapid deployment valve (R-SAVR) were designed to simplify and accelerate a conventional or less invasive surgical procedure while allowing complete excision of the calcified native valve. From 3 different implants tested more than 10 to 15 years ago, only two are available on the market today: the Perceval® valve from Liva Nova and the Intuity® sutureless prosthesis from Edwards Lifesciences. There has been extensive experience with these two devices in previous years and the results obtained are comparable to those observed following the use of conventional implants. The sutureless devices may be of particular interest for more complex and combined surgical procedures. This review summarizes the sutureless (SU-SAVR) and rapid deployment valve technologies and presents a clinical outlook for the patient population managed with these devices.

Successful Reoperation in 3 Cases of Failed Sorin Freedom Stentless Aortic Valve Using the LivaNova Perceval Sutureless Prosthesis.

Reoperations for deteriorated stentless bioprostheses are quite challenging procedures. Calcification of the aortic annulus and of the subcoronary root makes often impossible the removal of the failed valve, living a complex Bentall operation or a high-risk transcatheter aortic valve implantation valve-in-valve procedure as the only options, particularly in cases of small-size prostheses. The Perceval sutureless prosthesis (LivaNova PLC, London, UK) can be a valid alternative for failed stentless valve replacement. We report our experience with 3 complex cases of degenerated Sorin Pericarbon Freedom prosthesis treated successfully by means of Perceval sutureless implantation and demonstrating the reproducibility and the safety of this surgical approach.

Early and late pace‐maker implantation after transcatheter and surgical aortic valve replacement

Conduction defects requiring permanent pacemaker (PPM) implantation are frequent complications occurring after surgical (SAVR) and transcatheter aortic valve replacement (TAVR). Patients who underwent TAVR or SAVR with a bioprosthesis from the nationwide FinnValve registry were the subjects of this study. Patients with prior PPM, who received a sutureless prosthesis, or required cardiac resynchronization therapy or implantable cardioverter defibrillator were excluded from this analysis. Four thousand and ten patients underwent SAVR and 1,897 underwent TAVR. TAVR had an increased risk of PPM implantation at 30-day (10.1% vs. 3.5%, unadjusted OR 3.11, 95%CI 2.56-3.87) and 5-year (15.7% vs. 8.6%, unadjusted SHR, 2.12, 95%CI 1.81-2.48) compared to SAVR. PPM implantation within 30 days from the index procedure did not increase the risk of 5-year mortality after either SAVR or TAVR. Among 1,042 propensity score matched pairs, TAVR had an increased risk of PPM implantation at 30-day (9.9% vs. 4.7%, p < .0001) and 5-year (14.7% vs. 11.4%, p = .001), but late (>30 days) PPM implantation at 5-year (4.7% vs. 6.9% SHR 0.72, 95%CI 0.47-1.10) was comparable to SAVR. The types of prosthesis had an impact on 30-day PPM implantation after TAVR, but not on late (>30 days) PPM implantation. Although the risk of 30-day PPM implantation is higher after TAVR compared to SAVR, late (>30 days) PPM implantation was comparable with these treatment methods. PPM implantation within 30 days did not affect late survival.

Outcomes and hemodynamics of Enable bioprosthesis in 432 patients: an afterword

Aims To report the largest single-center experience in surgical aortic valve replacement (SAVR) using the Enable sutureless bioprosthesis concerning the clinical outcome and hemodynamic behavior. Material and methods From April 2010 to May 2017, a total of 432 patients (36.3% of them women) received the Enable sutureless prosthesis for aortic valve stenosis, regurgitation, and/or endocarditis. The endpoints were overall survival after operation for 30 days and adverse events. Results No intraoperative complications occurred; intraoperative mortality was 0%. The 30-day mortality rate was 3.5% overall and 0.9% for isolated procedure. No valve-related deaths were observed. There was a need for prosthesis replacement during the early postoperative period in eight patients (1.9%): seven patients (1.6%) had a significant paravalvular leak and one patient (0.2%) developed early postoperative endocarditis. The maximum and mean pressure gradients across the prosthesis were 19.2 ± 7.1 mmHg and 11.1 ± 4.6 mmHg, respectively. A permanent pacemaker was necessary in 6.5% of the patients. Conclusions The Enable sutureless prosthesis showed a reliable clinical outcome with low perioperative mortality and morbidity. The hemodynamic performance was satisfactory. Our data confirmed the safety of SAVR using the Enable bioprosthesis. However, a higher rate of pacemaker implantation (6.5%) has to be mentioned.

Modern concepts from old ideas in manufacture of cardiac valve prostheses.

In reviewing the history of mechanical prosthetic valves, it appears evident how many improvements and technical advances have been obtained in this field. Looking to the past, it must also be underlined how some old concepts, which can be considered quite revolutionary for those years, clearly indicate the great skill and ingenuity of those who conceived them. Old ideas have been revitalized by modern concepts, and this is exemplified when considering the developments of bileaflet and sutureless prostheses.

Minimally Invasive Aortic Valve Replacement with Sutureless Valves: Results From an International Prospective Registry

To report the early and mid-term results of patients who underwent minimally invasive aortic valve replacement (MI-AVR) with a sutureless prosthesis from an international prospective registry. Between March 2011 and September 2018, among 957 patients included in the prospective observational SURE-AVR (Sorin Universal REgistry on Aortic Valve Replacement) registry, 480 patients underwent MI-AVR with self-expandable Perceval aortic bioprosthesis (LivaNova PLC, London, UK) in 29 international institutions through either minithoracotomy (n = 266) or ministernotomy (n = 214). Postoperative, follow-up, and echocardiographic outcomes were analyzed for all patients. Patient age was 76.1 ± 7.1 years; 64.4% were female. Median EuroSCORE I was 7.9% (interquartile range [IQR], 4.8 to 10.9). Median cardiopulmonary bypass and cross-clamp times were 81 minutes (IQR 64 to 100) and 51 minutes (IQR 40 to 63). First successful implantation was achieved in 97.9% of cases. Two in-hospital deaths occurred, 1 for noncardiovascular causes and 1 following a disabling stroke. In the early (≤30 days) period, stroke rate was 1.4%. Three early explants were reported: 2 due to nonstructural valve dysfunction (NSVD) and 1 for malpositioning. One mild and 1 moderate paravalvular leak were reported. In 16 patients (3.3%) pacemaker implantation was needed. Mean follow-up was 2.4 years (maximum = 7 years). During follow-up 5 explants were reported, 3 due to endocarditis and 2 due to NSVD. Follow-up stroke rate was 2.5%. Three structural valve deteriorations not requiring reintervention were reported. Five-year survival was 91.45%. In this large prospective international registry, MI-AVR with Perceval valve confirmed to be safe, reproducible, and effective in an intermediate-risk population, providing excellent clinical recovery both in early and mid-term follow-up.

The “Chaperone Technique”: Valve-in-Valve TAVR Procedure With a Self-Expandable Valve Inside a Degenerated Sutureless Prosthesis

The “Chaperone Technique”: Valve-in-Valve TAVR Procedure With a Self-Expandable Valve Inside a Degenerated Sutureless Prosthesis

Sutureless and Transcatheter Aortic Valve Replacement: When Rivals Become Allies

In recent years, sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve replacement (TAVR) have emerged as viable alternatives to standard surgical aortic valve replacement (AVR) in higher risk patients. We report 7 cases in which SU-AVR and TAVR were used as bailout procedures for each other. Between June 2011 and August 2018, 626 patients underwent SU-AVR with the Perceval S prosthesis, and 588 patients underwent TAVR at the Montreal Heart Institute. Herein, we report the cases of 7 patients who underwent both procedures within a short time frame: 3 patients who underwent SU-AVR with a Perceval prosthesis after a failed TAVR procedure, 3 patients who underwent TAVR after degeneration of a surgically implanted Perceval sutureless prosthesis, and 1 patient who was scheduled for multiple percutaneous interventions-including TAVR, right coronary angioplasty, atrial fibrillation ablation with left atrial appendage occlusion-who suffered a periprocedural complication requiring an emergent surgery, during which a Perceval sutureless prosthesis was deployed. All patients were discharged home alive. Two patients suffered a complete heart block requiring permanent pacemaker implantation. We demonstrate that SU-AVR with the Perceval S prosthesis and TAVR are complementary procedures within the therapeutic armamentarium to treat aortic valve disease in higher risk patients. Specifically, valve-in-valve TAVR is an attractive option in the setting of Perceval prosthesis degeneration, whereas SU-AVR is a useful bailout option in the context of periprocedural failure of a TAVR.

Perceval S Sutureless Prosthesis in Aortic Valve Replacement

BACKGROUND In 12–47% of patients, there is a need to repeat the aortic valve replacement due to various valve-related complications in the immediate and late postoperative period. The standard operation of repeated aortic valve replacement is a complex procedure and it is associated with an increased risk due to adhesions in the pericardial cavity, previously performed coronary bybass surgery, diffculties of excision of the previously implanted prosthesis, narrow fbrous aortic valve ring and aorta. In 2007, the sutureless Perceval S aortic valve bioprosthesis (Sorin Group, Italy) was introduced into clinical practice. One of the advantages of such a prosthesis is the convenience of its anatomical positioning during repeated operations and the absence of the need to fx the prosthesis with sutures. The aim of study was to summarize the experience of sutureless implantation of the aortic valve prosthesis during repeated replacement.MATERIAL AND METHODS We report the results of treatment in 3 patients with valve-associated complications, who underwent aortic valve repeated replacement with the Perceval S sutureless prosthesis.RESULTS There were no hospital mortality and paraprosthetic regurgitation in the repeated replacement of the aortic valve with the Perceval S sutureless prosthesis. Two patients required implantation of a permanent pacemaker due to the development of a complete atrioventricular block, which was not related to the model of the prosthesis used.CONCLUSION The use of aortic valve prosthesis in cardiac surgery, which does not require fxation with sutures, allows non-standard decisions to be made in the surgical treatment of patients with various complications of previously performed aortic valve replacement and provides good immediate results if repeated replacement is necessary.

Sutureless Valve in Aortic Valve Reoperation: Results from an International Prospective Registry

Objective: To report the early and mid term results of patients who underwent aortic valve replacement (AVR) with a sutureless prosthesis in case of aortic valve reoperation (REDO) from an internat...

Sutureless aortic valve replacement in high risk patients neutralizes expected worse hospital outcome: A clinical and economic analysis.

Aortic valve replacement (AVR) by sutureless prostheses is changing surgeon options, although which patients benefit most, as well as their possible economic impact is still to be defined. Perceval-S prosthesis (LivaNova) is reserved, at the documented Institution, for patients at perceived high surgical risk. This retrospective analysis of outcome and resource consumption compared Perceval with other tissue valves. To clarify the comparison, only patients respecting 'instructions-for- use' of Perceval were reviewed. > 65 years, +/- coronary artery bypass grafting, patent foramen ovale closure or myectomy. bicuspid, combined valve or aortic sur- gery. Costs were calculated per patient on a daily basis including preoperative tests, operating costs (hourly basis), disposables, drugs, blood components and personnel. The sutureless group (SU-AVR) had a higher risk profile than the sutured group (ST-AVR). Cardiopulmonary bypass (CPB) and cross-clamp times were significantly shorter in SU-AVR (isolated AVR: cross-clamp 52.9 ± 12.6 vs. 69 ± 15.3 min, p < 0.001; CPB 79.4 ± 20.3 vs. 92.7 ± 18.2 min, p < 0.001). Hospital mortality was 0.9% in SU-AVR and nil in ST-AVR, p = 0.489; intubation 7 (IQR 5-10.7) and 7 h (IQR 5-9), p = 0.785; intensive care unit 1 (IQR 1-1) and 1 day (IQR 1-1), p = 0.258; ward stay 5.5 (IQR 4-7) and 5 days (IQR 4-6), p = 0.002; pacemaker 5.7% (6/106) and 0.9% (1/109), p = 0.063, respectively. Hospital costs (excluding the prosthesis) were $12,825 (IQR 11,733-15,334) for SU-AVR and $12,386 (IQR 11,217-14,230) in ST-AVR, p = 0.055. Despite higher operative risks in SU-AVR, hospital mortality, morbidity and resource consumption did not differ. Operative times were shorter with the sutureless device and this improve- ment, along with more frequent ministernotomy, may have improved many postoperative aims.

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

New postoperative conduction abnormalities after the implantation of a rapid-deployment aortic valve prosthesis

Sutureless and rapid-deployment aortic valves have enlarged the selection of prostheses available for surgical aortic valve replacement. However, the rate of postoperative pacemaker implantation seems to have increased. In addition to pacemaker implantation, we were interested in the incidence of new postoperative conduction abnormalities, namely left bundle branch block, right bundle branch block and atrioventricular block III after the implantation of the EDWARDS INTUITY Elite™ sutureless prosthesis. All patients undergoing isolated or concomitant surgical aortic valve replacement between May 2014 and May 2017 were included in the study. Two hundred patients were operated on. Of them, 14 patients dropped out because of concomitant endocardial or epicardial ablation or because of septal myectomy. Three more patients dropped out because the treatment was converted to conventional aortic valve replacement, and 183 patients remained. At the time of discharge from hospital, 38.1% of the 183 patients had new left bundle branch block, 2.5% of patients had new right bundle branch block and 9.6% had atrioventricular block III requiring either a pacemaker or defibrillator. The postoperative mean transvalvular gradient over the prosthesis was 8.4 ± 3.4 mmHg, the occurrence of paravalvular leakage more than trivial was 1% and hospital mortality was 3.3%. The incidence of new postoperative conduction abnormalities is considerable with the EDWARDS INTUITY Elite rapid-deployment aortic valve prosthesis. We will focus our future research on the follow-up of patients with postoperative left bundle branch block, which was the most frequently observed form of new conduction abnormality.

RF46 MINI-ACCESS ISOLATED AORTIC VALVE REOPERATION WITH PERCEVAL SUTURELESS PROSTHESIS

Background and aim: Literature data regarding the use of upper “J” hemi-sternotomy in reoperative aortic valve replacement show a reduction in the biological trauma primarily due to the limited mediastinal tissues dissection avoiding excessive blood loss. Based on encouraging results reported for minimally invasive aortic valve replacement and with sutureless prosthesis we decided to use the Perceval valve in redo aortic valve replacement with minimally invasive approach. Methods: Seven patients underwent redo aortic valve replacement using a sutureless Perceval bio-prosthesis with a minimally invasive approach: four (57%) patients received upper hemisternotomy and three (43%) a right minithoracotomy. The median age was 75.9 ± 5 years and 5 of them (71.4% of the cohort) was male.Mean preoperative euroSCORE was 10.7 ± 1.2. Previous operation included: coronary artery bypass grafts (n°3), isolated aortic valve replacement (n°2), combined procedure (n°2). Results: The operation was performed with total central cannulation in 6 (86%) patients, in the seventh the ascending aorta was cannulated but a femoral venous percutaneous cannula was preferred for extreme frailty of the right atrium. Mean cardiopulmonary bypass and aortic cross clamp times were 56.6 ± 29.8 (median 47) and 44.3 ± 26.9 (median 33) minutes. No conversion to full sternotomy was required. There was no hospital mortality within 30 days of operation. Conclusions: Mini-access isolated aortic valve surgery with sutureless prosthesis is a reproducible, safe and effective procedure also in case of reoperation. It can improve the outcome by minimizing trauma, preventing postoperative complications and it could be an alternative to valve in valve in selected patients.

EP13 EVOLUTIONARY AND CYCLICAL CHANGES IN CARDIAC SURGERY

Abstract Background and aim: The analysis of modern models and criteria discloses that current cardiac surgery often recalls the past. The aim of this study is to investigate whether historical knowledge is an important tool for research in aortic valve surgery and myocardial revascularization. Methods: PubMed, Scopus and Sciencedirect analysis of past and current literature were adopted to compare previous and current ideas. Results: In 1922, Graham and Allen introduced a cardioscope and a knife through the subclavian artery, or the left ventricular apex, to divide calcified aortic valve leaflets. This technique is a precursor of TAVI. The concept of sutureless prosthesis existed in the fifties and sixties. Hufnagel routinely implanted sutureless prostheses in the descending thoracic aorta to treat aortic insufficiency. The sutureless Magovern-Cromie valve has been implanted in orthotropic position from 1964 onward. The Sen's technique of trans-ventricular tunnels is a precursor of laser trans-myocardial revascularization. The Italian technique of internal mammary arteries ligature to treat angina pectoris, dating back to 1939 (Fieschi), and to the 50’ (Battezzati) was rediscovered, following 50 years of silence, in 2010. Endovascular occlusion of the mammary arteries by embolization has been suggested to treat patients suffering from angina not amenable to conventional revascularization techniques. Conclusions: Knowledge of old ideas and experiments, released from the technological constraints of their time, can be useful in current research. Ingenious theories that have fallen by the wayside can be brought back and explored again. History is a cycle. Heart valve surgery and myocardial revascularization are no exception.

VD19 TRANS-FEMORAL IMPLANT OF A BALLOON EXPANDABLE AORTIC VALVE IN A LEAKING SUTURELESS SELF-EXPANDABLE VALVE

Abstract We report the case of a 83-year-old woman affected by aortic valve stenosis who underwent a minimally invasive Perceval S (size M) implantation. Intraoperative monitorings ruled out any any valvular leakage or valve dislocation. On postoperative day 3, a trans-thoracic echocardiography revealed a severe aortic valvular regurgitation with an isolated partial collapse of the basal ring at the right coronary sinus, as confimed by additional imagings. Transfemoral percutaneous Edwards Sapien XT 23 mm was successfully deployed as aortic valve in-valve (A-ViV) interventionwith excellent result. Despite the suspicious of a sutureless prosthesis mismatch or an uncorrect placement of the Perceval S, we consistently suppose that the preoperative severe septal hypertrophy exacerbated by postoperative edema might have played a significant role in the eventual dynamic sutureless valve infolding. This report confirms the rare but possible sutureless vave related adverse events which may be corrected by the current transcatheter A-ViV procedures.

Prótesis sin sutura: ¿es posible reducir la tasa de bloqueos postoperatorios modificando la técnica de implante?

IntroductionAortic valve replacement with sutureless prosthesis PercevalS is associated with an increase in the rate of postoperative atrioventricular block that requires permanent pacemaker implantation compared to conventional bioprostheses. In our series, we modified the implant technique (minimum ballooning <5seconds, rigorous annular decalcification, advancement of the folded prosthesis to the left ventricle outflow tract and repositioning by traction of guide sutures). ObjectivesTo analyze the impact of the modification in the Perceval implant technique on the postoperative atrioventricular block rate which requires permanent pacemaker implantation. Material and methods438 patients underwent aortic valve replacement with Perceval prosthesis, excluding those corresponding to the initial phase of the program (6months, n=14), concomitant mitral surgery (n=18) or tricuspid (n=11) and pre-surgical pacemaker carriers (n=11). Two comparison groups were established; standard group (October 2013-November 2016, n=209) with standard implant technique. Modified group (December 2016-November 2017, n=184) with modified implant technique. We analyzed permanent pacemaker implantation rates (6months follow-up) and variables of interest between groups. ResultsImplantation rate of permanent pacemaker, standard and modified group (10.05% vs. 4.35%, P=.031, respectively). Age, standard and modified group (mean 78.15±0.34 vs. mean 74.90±0.47, P<.01, respectively). EuroscoreII, standard and modified group (mean 3.76±0.24 vs. mean 3.00±0.25, P=.03, respectively). There were no other significant differences between variables of interest. ConclusionsModification of the Perceval implant technique has been associated with a statistically significant reduction in the postoperative atrioventricular block rate requiring implantation of permanent pacemaker.

Aims and expectations of a prospective multicenter study on aortic valve surgery: (E-AVR registry)

Background: Treatment of severe aortic valve stenosis (SAVS) is a hot topic due to improved life expectancy of general population, improvement of diagnostic tools, and consequent increased number of patients requiring aortic valve surgery. Traditional aortic valve replacement and recent transcatheter aortic prosthesis implantation have reported comparable or non-inferior mortality in randomised controlled trials (RCTs). However, RCTs have the limitation of the predefined inclusion/exclusion criteria, and cannot completely reflect the ‘real clinical world’. Recently sutureless prostheses, often implanted via minimally invasive approaches, have been reported as an alternative strategy. However, their definitive impact on clinical results is not yet completely evaluated because of the limited sample size of patients population of most of published studies, based on monocentric patients series. Methods: The aim of this prospective multicentre registry including all patients referred for aortic valve surgery and treated with all available techniques is to obtain a ‘real-world’ scenario of the clinical results arising from current surgical options. Results: The research protocol enrollment phase is ongoing. Therefore we have not yet results to publish. When available, the research findings deriving from E-AVR registry will be presented in the scientific community in international congresses and published in peer review international journals in the fields of cardiac surgery and cardiology. Conclusions: This multicenter, prospective, European registry has been designed with the aim to cast light on a lot of controversial issues, particularly those regarding the impact of patient baseline risk factors as well as treatment methods for SAVR, with or without coronary artery bypass grafting (CABG), on the prognosis after treatment. We believe that the information derived from this registry can provide deep knowledge on the causes that lead to adverse outcomes after SAVR, to avoid them, and finally to identify the best treatment option for SAVS for each patient.

Sutureless Prosthesis Implantation and Ascending Aorta Replacement Through a Ministernotomy Approach.

A significant proportion of patients undergoing aortic valve replacement have a dilated ascending aorta; presence of an ascending aorta aneurysm is viewed as a contraindication for sutureless valve implantation for the potential risk of prosthesis dislodgment. We describe our technique of sutureless prosthesis implantation and concomitant ascending aorta replacement through an upper ministernotomy. Seven patients underwent aortic valve replacement with a sutureless prosthesis and concomitant ascending aorta replacement between November 2014 and October 2016. A J-shaped upper ministernotomy was performed in all patients. Diameter of vascular graft for the replacement of the dilated ascending aorta was chosen according to the size of the selected prosthesis, to recreate a ratio between diameters of the new sinotubular junction and the aortic annulus that should be less than 1.3. Postoperatively. no patient died in hospital. No paravalvular leakage or prosthesis dislodgment was reported. Mean ± SD cardiopulmonary bypass and cross-clamp times were 142 ± 52 minutes and 85 ± 18 minutes, respectively. In patients undergoing aortic valve replacement and ascending aorta replacement, sutureless valve implantation is a safe and reproducible procedure associated with good postoperative results.