Background: While AVR is currently the treatment of choice for symptomatic aortic stenosis, TAVI has evolved as an alternative option for inoperable or high-risk patients. Rapid deployment sutureless AV has been introduced into the market, as another less invasive AVR strategy for elderly and high-risk patients. We describe our initial experience with the Sorin Perceval and Medtronic Enable sutureless valves.
Methods: From December 2011, 35 consecutive elderly patients with small LVOT underwent sutureless AVR in our center. Mean age was 77±8 years. Median sternotomy was done in 25 patients (71%), and right minithoracotomy in 10 patients (29%). Logistic EuroScore was 7.7% and BMI was 28. NYHA FC was III/IV in 16 patients (46%) and II in all others. Sorin Perceval was implanted in 57% and Medtronic Enable in 43%.
Results: There was 100% successful deployment of the valve, with no in-hospital mortality. Mean cardiopulmonary bypass and cross-clamp times, were 71±31 and 46±19 minutes, respectively. Intensive care unit and ventilation times were 51±59 and 17±29 hours, respectively. Major complications included CVA in 2 patients (6%), re-open in one (3%) and new pacemaker in 3 patients (9%). Mean hospital stay was 7±3 days. Peak and mean gradients decreased from 66±24 and 46±13 at baseline to 23±7 and 13±6 at discharge. Early echocardiography demonstrated none/trivial aortic regurgitation in 97% of patients, mild in 1 patient (3%), and none with moderate or severe.
Conclusions: Sutureless AV implantation provides a safe and effective option to conventional AVR. Minimal incision and easy deployment can reduce cross-clamp and cardiopulmonary bypass times, reduce blood transfusion, and provide a safe strategy with potentially improved outcome in high-risk patients. These early results compare well with conventional AVR outcome, but larger series, randomized trials and long-term clinical and echocardiographic follow-up are still needed.
