Sutureless aortic valve prostheses

Abstract

Conventional surgical aortic valve replacement (AVR) is the ‘gold standard’ for treatment of severe or symptomatic aortic valve stenosis. The increasing age of patients and increasing comorbidities has led to the development of procedures to minimise operative time and reduce risks of surgery. One method of reducing operative times is the use of sutureless aortic valves (SU-AVR). We examine the current literature surrounding the use of SU-AVR. Alternatives to AVR are SU-AVR, sometimes referred to as rapid deployment valves, or transcatheter aortic valve implantation (TAVI). TAVI has been demonstrated to be superior over medical therapy in patients deemed inoperable and non-inferior in high and intermediate-risk patients compared with surgical AVR. However, the lack of excision of the calcified aortic valve and annulus raises concerns regarding long-term durability and possibly thromboembolic complications. TAVI patients have increased rates of paravalvular leaks, major vascular complications and pacemaker implantation when compared with conventional AVR. SU-AVR minimises the need for suturing, leading to reduced operative times, while enabling complete removal of the calcified valve. The increase in use of SU-AVR has been mostly driven by minimally invasive surgery. Other indications include patients with a small and/or calcified aortic root, as well as patients requiring AVR and concomitant surgery. SU-AVR is associated with decreased operative times and possibly improved haemodynamics when compared with conventional AVR. However, this has to be weighed against the increased risk of paravalvular leak and pacemaker implantation when deciding which prosthesis to use for AVR.

Is sub-commissural annuloplasty a safe adjunct to sutureless Perceval-S aortic valve implantation ?

“…are unpredictable before surgery and could hamper Perceval-S implantation. In such situations, the surgeon should typically substitute a sutured valve, which is more time consuming and may be challenging, especially through a minimally invasive approach [1][2][3][4] .…”

“…This is the only sutureless valve available on the market and presents several advantages. First, its implantation is rapid, simple and reproducible, which reduces aortic cross-clamping time [1][2][3][4] . Moreover, its collapsible design favors minimally invasive surgical approaches 5 and facilitates implantation in challenging situations such as redo operations or calcified aortic root 3,6,7 .…”

“…Moreover, its collapsible design favors minimally invasive surgical approaches 5 and facilitates implantation in challenging situations such as redo operations or calcified aortic root 3,6,7 . It also provides lower transvalvular gradients than conventional stented bioprothesis 1,4,8 . Recent studies have shown that Perceval-S' rate of adverse events (notably renal insufficiency and blood transfusion) are similar or lower to that of conventional bioprothesis [1][2][3] , while mortality and paravalvular leak rates are lower than in TAVI 3,[9][10][11][12] .…”

New Insights into Valve Hemodynamics

“…12 One rationale for this change is the extensive use of transcatheter aortic valve implantation (TAVI) and the ability to treat bioprosthetic valve failure with a valve-in-valve (ViV) procedure, 13,14 thereby avoiding repeated open heart surgery. An additional option for rapid deployment of surgical bioprosthetic valves is the use of sutureless aortic valves 15 ; however, these valves may increase the risk for complications that are usually associated with TAVI (described in the next section).…”

Commentary: The role of sutureless aortic valves in the transcatheter aortic valve replacement era

“…2,3 Correspondingly, no study has yet been able to demonstrate a significant mortality benefit of a minimally invasive approach or SV compared with stented SAVR. 4 An alternative explanation for the differences is the iteration of devices used for this study and the lack of adjudication by core laboratories on key variables. While there have been trivial modifications of the SV over the study period, there has been significant modifications to the TAVR prostheses.…”