Sutureless aortic valve replacement in patients who have bicuspid aortic valve

Abstract

Objective: Bicuspid aortic valve (BAV) is generally considered to be a contraindication to sutureless aortic valve replacement (AVR). The aim of this study was to evaluate the feasibility and perioperative outcomes of this technique in patients with BAV.Methods: From June 2011 to January 2014, a total of 25 patients who underwent sutureless AVR had documented BAV. Thirteen patients (52%) had median sternotomy, and 12 patients (48%) a minimally invasive approach. Results:The study population included 17 (68%) men with a median age of 77.8 AE 5.4 years. The mean EuroSCORE II was 3.4% AE 2.6%. Concomitant procedures included coronary artery bypass grafting in 8 patients (32%), 2 AVRs (8%), 1 mitral valve repair (4%), 1 septal myomectomy (4%), and 1 atrial septal defect closure (4%). The mean transaortic valve gradient decreased from 49.4 AE 15.7, to 14.5 AE 5.4 mm Hg postoperatively. The mean aortic valve area increased from 0.78 AE 0.18, to 1.75 AE 0.43 cm 2 postoperatively. Five patients (20%) suffered from atrioventricular block that required permanent pacemaker implantation. Two patients (8%) suffered a stroke. No major paravalvular leakage occurred, and no postoperative valve migration. In-hospital mortality occurred in 1 patient (4%). The mean intensive care unit length of stay was 3 AE 2 days postoperatively.Conclusions: This study demonstrates that a sutureless aortic valve can be deployed in patients with BAV without increasing the risk of paravalvular leakage. BAV should not be considered a contraindication to sutureless AVR.

Dealing with a stenotic bicuspid aortic valve: Is this still an off-label procedure for a sutureless valve?

“…However, BAV has been always considered a contraindication for the implantation of a sutureless bioprosthesis due to its different anatomical aspects of the aortic root in terms of annulus geometry (more elliptic), sinus asymmetry, and leaflets commissures, which often have different heights especially in presence of pure bicuspid valve. In this Issue of the Journal, Nguyen et al retrospectively evaluated the feasibility and perioperative outcomes of sutureless aortic valve replacement in patients with bicuspid aortic valves for aortic stenosis [5]. Specifically, 25 patients with BAV received a Perceval S sutureless valve.…”

Perceval S sutureless prosthesis for aortic valve replacement in patients with concomitant coronary artery disease

“…Многие авторы [2][3][4][5][6][7][8][9][10] описывают свои результаты применения бесшовного протеза аортального клапана Perceval S у пациентов высокого риска с миниинвазивными доступами или при комбинированных вмешательствах. Однако анализа результатов выполнения ПАК бесшовным протезом совместно с аортокоронарным шунтированием в доступной литературе мы не встретили.…”

Perceval S and Coronary Artery Bypass Grafting, Contradiction or Full Harmony?

“…Several authors described their results with the use of Perceval S bioprostheses in high risk patients, with minimally invasive approach or in combined surgery [2][3][4][5][6][7][8][9][10]. However no one describes the experience of combined Perceval S aortic valve replacement with concomitant myocardial revascularization.…”