Sutureless Aortic Valve Replacement: Does It Make Sense?

Abstract

BACKGROUND Aortic valve stenosis is the most common valve disease in the elderly. Sutureless aortic valve replacement has been introduced as an alternative to conventional AVR in elderly high-risk patients. The aim of this study is reporting our single-center experience regarding early outcomes. METHODS Between December 2014 and December 2019, 91 patients (45 Women, 46 Males) were undergone aortic valve replacement in our clinic (49 Sutureless, 42 conventional). Perioperative clinical and echocardiographic outcomes were assessed in all patients. RESULTS The average age was 73.08±7.53 and 66.26±8.63 for sutureless and conventional groups. The mean cross-clamp time and the cardio-pulmonary bypass (CPB) time were 72.86 and 91.88 min, and 104.96 and 119.81 min, respectively. In sutureless group, 30 (61.2%) patients underwent additional procedures. These were CABG, mitral interventions, tricuspid repair, ascending aortic surgery and myxoma. Preoperative peak and mean pressure gradients decreased from 78.16 and 48.95 mmHg to 17.47 and 10.06 mmHg postoperatively for sutureless group. It was 71.53 and 43.89 to 29.16 and 15.14 for conventional group. Paravalvular leak and permanent pace-maker requirement due to AV-block rates were 6.1%. The mean ICU stay were 3.69 and 2.31 days, mean hospital stay were 10.08 and 8.62, 30-day overall mortality rates were 8.2% and 4.8% for sutureless and conventional groups. CONCLUSION The evaluation of our experience suggests that sutureless aortic valve replacement has advantages in terms of shorter cross-clamp and CPB duration, and postoperative aortic gradients. Its benefits could be more prominent in complex cases or minimally invasive surgery

Perceval S, sutureless aortic valve: cost-consequence analysis

“…In our study, length of both ICU and non-ICU stay was significantly decreased within the study group, and led to significant per-patient cost reduction. This is in line with previous findings of research on sutureless valves, and is additionally associated with lower complication rates among patients, apart from the reduced cost of the operation [ 24 , 30 , 31 ].…”