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Minimally invasive aortic valve replacement with sutureless valves by J-Sternotomy or right thoracotomy approach.
Giuseppe Santarpino, Steffen Pfeiffer, Giovanni Concistré, Ferdinand Vogt, Martin Hinzmann, Theodor Fischlein.
Klinikum Nürnberg, Nuremberg, Germany.

OBJECTIVE: Although minimally invasive aortic valve replacement (AVR) has been shown to cause less morbidity than conventional surgery, it has not yet received broad application. The purpose of this study was to evaluate sutureless implantation using a pericardial aortic valve bioprosthesis mounted in a nitinol stent in minimally invasive approach.
METHODS: 90 patients (51 females, 39 males; mean age 77.5 ± 4.6 years) with aortic valve stenosis (mean gradient of 52 ± 14 mmHg) underwent aortic valve implantation with the sutureless bioprosthesis, following cardiopulmonary bypass (CPB), aortic cross-clamping (ACC), cardioplegic arrest, and removal of the calcified native valve. Surgical approach was a mini ”J”-sternotomy in 85 and a anterior right thoracotomy in 5. The mean logistic EuroSCORE was 9.6 ± 5.7%.
RESULTS: The prosthetic valve was successfully deployed in all patients. Thirty-day mortality was 2.2% (n = 2). Associated procedures were performed in 9 (10%). Mean CPB, ACC and implantation times were 68 ± 19 min, 38.7 ± 12.7 min, and 9.1 ± 4.2 min, respectively. Perioperative echocardiography revealed a paravalvular leakage in two patients. Postoperative mean gradient was 11.6 ± 5.1 mmHg. At a mean follow-up of 14 ± 8.8 months, 3 no cardiac deaths were recorded. No significant paravalvular leakage or valvular regurgitation was observed, and no migration or dislodgement of the prosthesis occurred.
CONCLUSIONS: This study shows that sutureless implantation of this aortic valve bioprosthesis provides a simple and reproducible alternative for minimally invasive AVR. As the valve does not need to be sutured, it may also result in reduced ACC and CPB times, especially in mini approach. Therefore, this self-anchoring valve may also allow the application of minimally invasive AVR to a broader spectrum of patients.


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