International Society For Minimally Invasive Cardiothoracic Surgery

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Suturless Aortic Valves In Redo Situations
Gry Dahle, Kjell Saatvedt, Jon Offstad, Kjell Arne Rein.
Rikshospitalet, OUS, Oslo, Norway.

Introduction Biological prostheses and homografts tend to degenerate, both with stenosis and regurgitation in need of a second operation. The homograft body tends to calcify, and the part just above the annulus ring will dilate. A surgical aortic valve may sometimes be difficult to implant due to fibrosis and calcification. Sutureless aortic valves may ease procedure and reduce procedural time. Material and method Five patients, two females, aged 30-78 years (median 48) with one aortic regurgitation (endocarditis) and one stenosis in bioprostheses, two failed homografts and one mechanical prosthesis with pannus were referred for redo surgery. CT reconstruction of the heart and echocardiography was performed. The mechanical prosthesis and the bioprostheses with endocarditis and stenotic degeneration were removed before deploying the sutureless valve. The sutureless valve was deployed in the homografts after removal of the deteriorated cusps. Results All five patients had successful implantation of the sutureless valve with good hemodynamics. In general, the patients received a larger sutureless valve than the previously implanted prostheses. There were no death, perioperative myocardial infarction or cerebral stroke. Conclusion Sutureless valves may be an alternative in redo situations both after explantation of the first valve as well as inside the bioconduit (homograft) and deploying inside the original prosthesis. Homgrafts tend to calsify in the body part, preferably an aortotomy should be done above. CT reconstruction is useful to get a preliminary impression of the size needed as well as dimensions of ascending aorta and calcification

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