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Objective: Minimally invasive aortic valve replacement (MIAVR) has shown excellent results in terms of mortality, morbidities and patient satisfaction. However, several studies have reported longer cardiopulmonary bypass (CPB) and crossclamp (CC) times compared with conventional surgery, raising some concerns on its safety in elderly and high-risk patients. Sutureless valves have shown good results in term of reduction of operative times and hemodinamic performances. Therefore, aim of our study was to evaluate the effect of Perceval sutureless valve on CPB and CC times in patients undergoing MIAVR.
Methods: From January 2005 and December 2011, 406 patients underwent MIAVR via either right minithoracotomy (RT, n=251 patients, 61.8%) or upper V type ministernotomy (MS, 155 patients, 38.2%). Of these, 19 (4.9%) patients received sutureless Perceval S valve: 15 (78.9%) patients via RT and 4 (21.1) patients via MS.
Results: Overall in-hospital mortality among patinets undergoing MIAVR was 1.1% (5 patients) with a median predicted EuroSCORE mortality of 6% (range interquartile [RI] 3.2%-11.6%). No death occurred in patients receiving the sutureless Perceval valve (predicted EuroSCORE mortality 11%, RI 5%-43%). In the RT group, patients receiving sutureless Perceval S valve had shorter CPB time (75.8±19 min vs 128±44.2 min, p<0.0001) and CC time (50.5±14.5 min vs 93.2±33.4 min, p<0.0001) than those who had standard prosthesis valve. Moreover, in the MS group, Sutureless Perceval valve was associated with shorter CPB time (81.7±23.3 min vs 125.4±44.5 min, p<0.0001) and CC time (44.2±8.4 min vs 85±28.7 min, p<0.0001) than those receiving standard prosthesis valve. Ninety-five % (n=18) of Perceval S patients were discharged home with a median hospital stays of 7 days (RI 5-9). At discharge, 17 (90%) patients showed no paravalvular leak, 2 patients had mild (5%) and moderate (5%) paravalvular leak, respectively.
Conclusions: In patients undergoing MIAVR, sutureless Perceval valve implantation is a safe and reproducible procedure associated with excellent postoperative outcomes and shorter operative times.