Sutureless Aortic Valve Replacement is Useful in Extreme Surgical Conditions of the Aortic Root

Objective: Sutureless aortic bioprosthetic valves offer good hemodynamics and low gradients. We aimed to describe utilization of sutureless valve, enabling rapid, safe and effective solution in patients who presented with major difficulties in standard valve suturing.

Methods: Three patients are described: the first patient had an extremely calcified aortic annulus due to the presence of degenerative aortic homograft. The aorta, aortic root and aortic-mitral continuity were “porcelain”. The presence of endocarditis has not ruled out. The second patient, who received irradiation to his mediastinum, developed severe calcifications of the aortic valve, mitral valve and aortic-mitral continuity resulting in severely calcified and small aortic annulus. The Third patient underwent re-re-do operation due to stuck aortic mechanical 19 mm (that had been implanted years ago) 3 months after a complicated mechanical mitral and tricuspid valve replacement. Following explantation of the mechanical aortic valve, a very small annulus with a limited aortic-mitral continuity was remained.

Results: In the first patient, the sutureless valve was implanted without the recommended guiding suture due to inability to pass a needle in the calcified aorta. All valves were well positioned and demonstrated good hemodynamics. No para-valvular leak was noticed. The mean transvalvular gradient was 8mmHG. None of the patients required a pacemaker; neither mortality nor stroke was recorded. The second patient presented with a significant intravalvular and paravalvular leak 3-month post the operation. Therefore, TAVI was performed with elimination of the leak.

Conclusions: Sutureless aortic valve replacement in a heavily calcified, small aortic root or other extremely complicated aortic root scenarios, allows rapid, safe and effective procedure. A redo root replacement operation with its known morbidity in this subset population can be avoided by using this technology.