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Minimal invasive aortic valve replacement: is the sutureless technology a real advantage?
Steffen Pfeiffer, Giuseppe Santarpino, Joachim Sirch, Ferdinand Vogt, Theodor Fischlein.
Klinikum Nürnberg, Nuremberg, Germany.

OBJECTIVE: Minimal invasive aortic valve replacement (MIAVR) causes less morbidity than conventional surgery, but it has not yet received broad application. Sutureless aortic valve prosthesis provides a simple and reproducible alternative for MIAVR because of the potential of shortening surgical time. However, whether shorter operative times in minimal invasive field may also result in improved patient outcomes remains to be established.
METHODS: From March 2010 to March 2013, 469 patients underwent minimally invasive isolated aortic valve replacement through upper ministernotomy either with a Perceval sutureless valve (group P, n = 159) or another aortic valve prosthesis (group NP, n = 310) at our cardiac center.
RESULTS: The group P patients were older (78 ± 4.6 versus 68.7 ± 10 years, p < 0.001) and at higher risk (logistic EuroSCORE 11.1 ± 8.7 versus 9 ± 1, p = 0.019) than Group NP patients. Aortic cross-clamp, cardiopulmonary bypass and operation times were 40.8% , 37.1% and 16.7% shorter in
group P (35.9±10.7 vs 60.7±18.8 minutes - p < 0.001; 62.7±17.5 vs 99.7±30.6 minutes - p < 0.001; 143.2±55.7 vs 171.9±58.2 minutes - p < 0.001, respectively). Within 30 days, a total of 10 patients died, 2.1% (3 - 1.9% in group P and 7 - 2.3% in group NP, p = 0.54). Despite the higher surgical risk, group P patients required no more blood transfusions (1.2 ± 1.7 units versus 1.2 ± 2.4 units, p = 0.88), no more hospital stay (12.8 ± 9 versus 12.9 ± 9.9 days, p = 0.94) and a - but not significant - 46% shorter intubation time (20.7 ± 86 hours versus 38.2 ± 148.6 hours, p = 0.17). Group P patients had a mean prosthesis size significantly larger than for group NP (24.2 ± 1.6 mm versus 23.2 ± 1.8 mm, p < 0.001).
CONCLUSIONS: Sutureless implantation of the Perceval valve is associated with shorter cross-clamp, cardiopulmonary bypass and surgical times, comparing it with conventional aortic valve prosthesis. In addition, it showed same clinical results in terms of mortality and outcome variables despite significant higher risk patients.


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