Early Clinical Experience with Sutureless Aortic Valve Replacement for Severe Aortic Stenosis

Abstract

Background: Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment f or p atients with s ymptomatic s evere aortic stenosis ( AS). The aim o f this s tudy w as t o evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. Methods: From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was 18.1±8.6 months. Results: The mean age of the patients was 77.1±5.8 years and their mean Society of Thoracic Surgeons score was 9.2±17.7. The mean cardiopulmonary bypass and aortic cross-clamp times were 94.5±37.3 minutes and 54.9±12.5 minutes, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, 13.9±8.6 mm Hg and peak, 27.2±15.0 mm Hg) at a mean of 9.9±4.2 months. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was 83.3%±10.8%. Conclusion: Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.

Keywords

• Aortic valve stenosis
• Bioprosthesis
• Heart valve prosthesis implantation