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Surgical Treatment of Prosthetic Valve Endocarditis: Is the Sutureless Technology a New Viable Option?
Antonio Lio, Antonio Miceli, Matteo Ferrarini, Mattia Glauber.
Cardiac Surgery and Great Vessel Department, Istituto Clinico Sant'Ambrogio, Milan, Italy.

Surgical Treatment of Prosthetic Valve Endocarditis: Is the Sutureless Technology a New Viable Option?
Objectives. Prosthetic valve endocarditis (PVE) is a serious illness with significant mortality after cardiac surgery (20% to 80%). The choice of the optimal prosthesis for aortic valve replacement (AVR) is still debated. The objective of this study is to evaluate results of the initial experience with sutureless valve implantation for active PVE.
Methods. A retrospective study was undertaken on 6 consecutive patients who underwent surgery for aortic PVE with sutureless bioprosthesis from October 2012 to December 2015. Follow-up was 100% complete. Relapse and reinfection were recorded.
Results. There were 5 men and 1 woman, with a mean age of 71.5 ± 5.8 (range, 65 - 79 years). Mean logistic EuroSCORE was 25.8 ± 16.6%. Mean cardiopulmonary bypass and aortic cross-clamp times were 158 ± 47 and 92 ± 19 minutes, respectively. Two patients (33%) underwent concomitant surgical procedures: one tricuspid valve replacement (TVR) and one ventricular septal defect repair.
There was one in-hospital death (16%). Median Intensive Care Unit stay was 2 days. Echocardiography performed at discharge showed excellent haemodynamic performance of the bioprosthesis and no significant aortic regurgitation.
At the median follow-up of 18 month (range 0 to 21 months), 1 late death occurred due to neoplastic disease. Freedom from reoperation, relapse or reinfection was 100%.
Conclusions. AVR with sutureless valve in patient with PVE is a feasible and safe procedure, associated with low in-hospital mortality and good haemodynamic performance of the prosthesis.
Table 1.
Number of patients (n)6
Mean age (y) ± SD71.5 ± 5.8
Male5 (84%)
NYHA class III-IV4 (66%)
Hypertension4 (66%)
Diabetes0 (0)
Dyslipidemia2 (33%)
COPD1 (16%)
Peripheral vascular disease1 (16%)
Chronic renal failure 2 (33%)
Previous stroke0 (0)
Preoperative AF0 (0)
Pulmonary hypertension (PAP > 50 mmHg)1 (16%)
Logistic EuroScore %± SD25.8 ± 16.6
Operative deaths1 (16%)
Re-exploration for bleeding1 (16%)
Perioperative AMI0 (0)
Stroke0 (0)
Acute renal injury2 (33%)
PMK implantation0 (0)
Atrial fibrillation1 (16%)
Pulmonary complications2 (33%)
Peak gradient (mmHg)18.8 ± 1.5
Mean gradient (mmHg)10.4 ± 1.1
AR ≥ 2+/4+ (n, %)0 (0)

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