Sutureless aortic valve implantation – experience in over 70 patients

Objective: In this single center study we investigated the feasibility and benefits of sutureless valve implantation in elective and high risk patients with severe aortic valve disease

Methods: From 7/2010 to 8/2011, in total 71 pts (mean age 76.6yrs, range 55–88yrs) underwent aortic valve replacement (AVR) with a sutureless aortic valve prosthesis (Enable I, Medtronic). TEE was performed pre- and intraoperatively and at time of discharge. Peak (PP) and mean pressure (PM) gradients were measured. Logistic euroscore (Log ES) was determined.

Results: Overall 33/71 pts received isolated AVR (46.5%). In 38% concomitant bypass surgery was performed. 8/71 pts underwent additional surgery for atrial fibrillation (11.3%). Mitral valve surgery was performed in two pts, ASD closure in one. Log ES was 20.5% (3.5–66.6%). Mean aortic cross clamp time was 33 mins (18–60mins), mean bypass time 52 mins (41–114mins). Prosthesis sizes of 23mm (n=26) and 25mm (n=22) were implanted most often. Pressure gradients at time of operation and discharge were: PP 14mmHg (8–21mmHg) and PM 9mmHg (4–13mmHg). By echo, four trivial paravalvular leckages (PVL) had been detected, in 5 pts misplacement of the prosthesis was detected intraoperatively and resulted in immediate correction with second aortic crossclamp. Two pts were reoperated on postoperative day 5 (after resuscitation) and after 4 months (major PVL), respectively. 5 none valve-related deaths (7%) occured during the postoperative observation period.

Discussion: We implanted the sutureless aortic valve prosthesis in a variety of different pts who needed isolated AVR or in combination with other cardiac procedures. Implantation of Enable I aortic valve prosthesis is easy and safe but requires distinct positioning. It can be used in a variety of different sizes and indications with excellent functional results and offers the possibility of time savings, especially in high-risk patients and concomitant surgeries. Trivial PVLs in the postoperative period have to be observed closely.