Sutureless Aortic Valve Replacement In Octogenarians - Comparative Analysis With The Sutured Valves
Mukesh Karuppannan, Grzegorz Laskawski, David Rose, Antony Walker, Amal Bose, Carmelo Raimondo, Mohamad Nidal Bittar, Joseph Zacharias.
Lancashire Cardiac Centre,Blackpool Victoria Hospital, Blackpool, United Kingdom.
Background: As more people survive into their ninth decade, there is an increasing prevalence of aortic valve disease requiring intervention. This study sought to identify the early and long term outcomes of sutureless prosthetic valves in this selected patient group and compare it to the conventional sutured valves. Methods: A retrospective review of prospectively collected data from all patients aged over 80 who underwent surgical aortic valve replacement (sternotomy / minimal access approach (MICS)) between January 2011 and December 2021 were analysed. Patients who underwent redo operations, concomitant aortic replacement or multi valve procedures were excluded. Primary outcomes were 30-day mortality and morbidity and secondary outcome was one & 5-year survival. Results: Out of the 389 patients (mean age 83.0 ± 2.7 years, Females 50.8%) who underwent surgical aortic valve replacement, sutureless valve was implanted in 89 (22.1%) with 10.4% by the MICS approach . The mean logistic EuroSCORE was 14.03 ± 8.7 (14.8±11.8 in sutured valve group). The mean aortic cross clamp time was shorter in the sutureless valve group(50.8±27.6 mins vs 86.4 ±28.8 mins,p<0.0001) The median length of post operative ICU stay was 1 day (IQR-0) and the total post operative hospital stay was 9 days (IQR-7) in both the groups .The morbidity among both the groups were acceptable and similar(table.1), except that there was increased incidence of pacemaker implantation in the sutureless valve group ( 5.8% vs 1.6%,p=0.03) .The 30 day and 1 year survival were similar between the groups (97.6% and 90.7% sutureless vs 96.7% and 92.7% sutured valve group.p=0.6,p=0.2 respectively ) and the 5 year survival of both the groups were 75.5%(p=0.6) Conclusion: This study confirms surgical AVR is safe in selected octogenarians with excellent short and long results. The use of sutureless valves appears to reduce intraoperative times but this does not convert to any obvious clinical advantage in the short or long term.
Table.1 Outcomes of surgical AVR using sutureless and sutured valves in Octogenarians between Jan 2011 and December 2021 
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