New cardiac bioprostheses: The case of 'sutureless' valves

Abstract

Surgical aortic valve replacement (SAVR) with extracorporeal circulation (ECC) is currently the treatment of choice for patients with severe aortic stenosis, but high-risk patients may benefit from reduced ECC and cross-clamping times (CCTs) and a minimally invasive approach. A new generation of 'sutureless' (SU) bioprostheses has recently been introduced into clinical practice. Sutureless fixation of the valve combines the advantages of open SAVR (i.e. complete removal of pathological tissue) with reduced ECC and CCT, and facilitates small incision surgery. Between November 2012 and August 2014, we operated on 49 consecutive patients with aortic valve stenosis, using SU valves. Patients (18 males, mean age 78.9 ± 6.3 years, range 63-91) had a mean logistic EuroSCORE of 10.9 ± 10.8. Thirty-nine patients received a Medtronic 3f Enable and 10 a Sorin Perceval S valve; 24 patients underwent minithoracotomy, 11 ministernotomy, and 14 full sternotomy. Valve implantation resulted in a significant improvement in symptoms; mean preoperative and postoperative transvalvular gradients were 60 (120-40) mmHg and 8.5 (17-7) mmHg, respectively. Cross-clamping time was 55.6 ± 14.4 min, mean ECC time 71 ± 19.8 min, and mean implant time 9 min. There was no 30-day mortality. Early incidence of grade I paravalvular leakages and pacemaker implantation was, respectively, 2.0 and 4%. No perivalvular leak >grade I was registered. Aortic valve replacement with SU aortic bioprosthesis represents a safe and effective treatment for aortic valve stenosis, providing excellent haemodynamic and clinical results. A larger study is needed to confirm these initial promising results.