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Sutureless aortic valve replacement in octogenarians: a timesaving solution
Ferdinand A. Vogt, Giuseppe Santarpino, Laszlo Gazdag, Steffen Pfeiffer, Theodor Fischlein.
Klinikum Nuremberg, Nuremberg, Germany.

OBJECTIVE: The era of transcatheter aortic valve implantation has given rise to an intense debate on the most appropriate treatment strategy in an elderly population. The aim of this study was to show clinical outcomes in octogenarians undergoing sutureless aortic valve replacement (AVR).
METHODS: Between May 2010 and November 2013 203 patients underwent AVR with a sutureless bioprosthesis. Out of these we evaluated 83 patients (44 females = 53%) with an age ≥ 80 years with a mean age of 82.8±2.5 years, Patients received prosthesis in size S (4), M (33), L (37) or XL (9). 46 underwent isolated minimally invasive AVR, 34 had combined procedures (26 CABG, 8 others) and 3 needed a redo-procedure. Clinical follow up data like in-hospital mortality and echocardiography was collected for all patients.
RESULTS: Mean logistic EURO-Score was 13.2±7.6%, Overall mean aortic cross-clamp time was 43.2±15.9 minutes. For isolated procedures cross-clamp time was 38.4±12.7 minutes. Mean implantation time with placement and development of the sutureless prostheses was 7.7±2.9 minutes. In-hospital mortality was 4.8% with one cardiac event; mean hospital stay was 11.8±3.1 days. We recorded the need of 7 pacemaker implantations (8.3%). During follow-up (19±11 months), we observed 2 deaths (1 patient for congestive heart failure and 1 for gastrointestinal bleeding). Echocardioographic evaluation showed a mean transprosthetic gradients of 12.1±3.3 mmHg, significant left-ventricular-mass-regression and no paravalvular leakages.
CONCLUSIONS: The study results showed a good clinical outcome in patients at the age of 80 or above undergoing a sutureless implant. Especially in isolated AVR sutureless valves in a minimal invasive approach allows short cardio pulmonary bypass time and aortic cross-clamp time. Therefore sutureless AVR should be considered in elderly high risk patients.

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