Objectives
Aortic valve replacement with a sutureless prosthesis (Su-AVR) is an option for patients with severe aortic valve stenosis. However, data regarding long-term outcomes and prosthesis durability are still lacking.
Methods
All consecutive patients who successfully underwent Su-AVR with the Perceval valve in our center between 2010 and 2020 were included in the analysis and followed prospectively with echocardiography. Risk factor analysis was performed to assess variables associated with worse survival and bioprosthetic valve failure.
Results
Study population consisted of 547 patients: mean age was 76.4 (5.2) years, 51% were female, and mean logistic EuroSCORE was 13% (11). The median survival was 7.76 years (95% CI = 6.9–8.6). Risk factor analysis identified age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03–1.11; p < 0.001), EuroSCORE II (HR 1.08, 1.02–1.13; p < 0.001), baseline dialysis (HR 2.14, 95% CI 1.4–4.4; p = 0.038) and postoperative acute kidney injury ≥2 (HR 8.97, 95% CI 4.58–17.6; p < 0.001) as factors significantly correlated with worse survival. The reported HRs for age are per one year and for EuroSCORE II is one percentage point. Structural valve deterioration (SVD) was observed in 23 patients, of which 19 underwent reintervention (median freedom from SVD 10.3 years). In multivariable Cox analysis, age (HR 0.89, 95% CI 0.82–0.95; p < 0.001) was found to be a significant predictor of SVD. Overall, 1.8% was referred for prosthetic valve endocarditis (confirmed or suspected) during follow-up. One patient showed moderate non-SVD and none developed prosthetic valve thrombosis.
Conclusions
The sutureless valve represents a reliable bioprosthesis for AVR in patients with a 10-year life expectancy. Younger age at time of implant is the only factor associated with the risk of long-term SVD.
Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (Su-AVR) enabled in the last years many patients at high or prohibitive risk to be treated for their severe symptomatic aortic valve stenosis. As often happens in medicine, new techniques bring not only new hopes, but also new problems. In recent years, alongside the lengthening of the life of these patients treated with TAVI or Su-AVR, cardiologists and cardiac surgeons have had to face the long-term complications associated with the implantation of these devices, such as the prosthetic infective endocarditis. The correct management of prosthesis valve endocarditis after TAVI or Su-AVR in high risk patients, and the possible role of surgery are a matter of debate because pushing the limits of the modern medicine and becoming a new challenge for cardiac surgeons of 21 st century. In this review, we summarized the incidence, characteristics and evidences for this new and controversial problem of the cardiovascular community. Moreover, we investigated the outcomes reported in literature of the conservative and the surgical strategy. Although the reported mortality rate of surgical treatment is high, seems not prohibitive, mostly if compared to conservative medical therapy.The collaborative exchange between cardiologist, cardiac surgeons, clinical microbiologists and expert of imaging is mandatory to face this challenge.
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