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Sutureless Prosthesis Option in Patients Undergoing Concomitant Aortic Valve and Ascending Aorta Replacement: First Experience in 13 Cases.
Objective: A significant proportion of patients undergoing aortic valve replacement (AVR) have a dilated ascending aorta that need concomitant surgical replacement. The objective of this study was to report our first experience on 13 patients undergoing AVR and concomitant ascending aorta replacement (AAR), with implantation of a sutureless prosthesis.
Methods: A retrospective study was undertaken on 189 consecutive patients undergoing AVR and AAR between January 2001 and December 2015. Propensity score matching was used to reduce selection bias. 13 patients treated with a sutureless prosthesis implantation (study group) were compared with a control group of 13 patients undergoing AVR and AAR with conventional mechanical/biological prosthesis.
Results: Both patients with aortic stenosis both patients with aortic regurgitation were treated with sutureless valve implantation. In sutureless group patients were more likely treated with a minimally invasive approach. Only 1 patient died in hospital. No paravalvular leakage or prosthesis dislodgment was reported. Permanent pacemaker implantation was needed only in 1 patient. Sutureless group has shown shorter cardiopulmonary bypass (142 ± 52 min vs 167 ± 38 min, P=0.01) and cross-clamp times (85 ± 18min vs 101 ± 29 min, P=0.01).
Conclusions: In patients undergoing AVR and AAR, sutureless valve implantation is a safe and reproducible procedure associated with good postoperative results.
Table 1. Results

Variables	Perceval S group (n=13)	Control Group (n=13)	P-value
Age (yrs±SD)	74.6 ± 8.7	74.4 ± 9.6	ns
Male n, (%)	7 (54)	6 (46)	ns
NYHA class (3-4), n (%)	4 (31)	4 (31)	ns
Diabetes, n (%)	1 (7.5)	1 (7.5)	ns
Previous operations, (%)	5 (38)	4 (31)	ns
Pulmonary hypertension	2 (15)	3 (6.2)	ns
LVEF (%)	54.7± 7.9	53.1± 13.6	ns
Aortic stenosis, n (%)	7 (54)	6 (46)	ns
Aortic regurgitation, n (%)	6 (46)	6 (46)	ns
Sternotomy, n (%)	6 (46)	10 (77)	0.03
Ministernotomy, n (%)	7 (54)	3 (6.2)	0.03
CPB time (min ± SD)	142 ± 52	167 ± 38	0.01
Cross-clamp time (min ± SD)	85 ± 18	101 ± 29	0.01
Hospital mortality, n(%)	1 (7.5)	1 (7.5)	ns
Permanent neurologic injury, n(%)	1 (7.5)	2 (15)	ns
Acute renal failure, n(%)	2 (15)	1 (7.5)	ns
Permanent PMK, n(%)	1 (7.5)	1 (7.5)	ns
ICU stay, median days (IQR)	1 (1-6)	1 (1-7)	ns