Isolated aortic valve replacement (AVR) with sutureless valves compares well against conventional biological aortic valves in Patients with small aortic-roots

Objective: Aortic valve replacement (AVR) in patients with small aortic roots is a technical challenge. The purpose of this study was to compare results of AVR with sutureless aortic valves (Sorin Perceval) against those with conventional biological valves in patients with small aortic-roots (annulus size <22mm) .

Methods: Between 4/2007 and 5/2011, 138 isolated AVR in small root were performed at our center. All the patients had symptomatic aortic valve stenosis.

Of these, 96 patients (7 males, age 78.1±5.4 years) received conventional biological valves (C-Group) and 42 patients (3 males, age 80.4±3.9 years) received sutureless valves (P-Group). Thirty of these patients (30/42) were operated via a minimally invasive access. The euroscore of C group was 7.0±2.6 and that of P group 10.9±7.3, respectively.

Results: There were no mortalities during the period of hospitalization in group P. In group C, 5 (5.2%) patients died (Fisher-Exact-Test: p=0.323) during hospital stay. The X-Clamp and CPB times of C group were 50.1±17.3 mins and 77.0±31.2 mins and that of P group were 31.0±9.4 and 60.9±21.9 mins, respectively. Both variables as tested by the U-Test were statistically significant with a p-value less than 0.001.

Conclusions: This trial highlights the advantages of the Perceval S sutureless valve. As the valve doesn't need to be sutured, AVR is technically easier, even in patients with small or calcified aortic roots. This is reflected in shorter X-clamp and CPB times even though most of these patients were operated via a minimally invasive access. These valves may enable broader application of minimally invasive AVR even in patients with small aortic roots.