Background: Aortic valve replacement (AVR) with a small aortic annulus may lead to patient-prosthesis-mismatch (PPM). Stentless valves, aortic root enlargement and even complete aortic root replacement are technically complicated and are not widely used. Sutureless valve can be an ideal solution for those patients. We compared results of AVR with sutureless valves versus stented bioprosthesis valves.
Methods: Between 2011 and 2014, 53 patients underwent AVR using sutureless prosthesis. Of them, 21 patients (19 female, age 77±6 years) had small annulus (group 1). Those patients were matched with 21 patients (19 female, 76±8 years) undergoing stented valve replacement (group 2). BMI and BSA were 27±4 and 28±5 (p=0.9), 1.6±0.2 and 1.6±0.1 (p=0.6), in group 1 and 2 respectively. The logistic EuroScore were similar between groups.
Results: Early mortality was similar between groups, one in each group. The cardiopulmonary bypass and cross-clamp time were 85±42 and 52±24 minutes (group 1) versus 97±22 and 76±18 minutes (group 2); p=0.16/p=0.01. Intensive care unit and ventilation times were 63±69 (25-68) and 21±36 (8-19) hours in group 1 versus 136±316 (19-103) and 32±56 (11-35) hours in group 2 (p=0.8/ p=0.2). Major complication were similar between groups, except permanent pacemaker in four patients (19%) in group 1 versus one patient (5%) in group 2 (p=0.375). Mean hospital stay was similar between groups. At follow up 83% and 80% were NYHA FC I/II, group 1 and 2, respectively (NS). Echocardiographic follow up demonstrated peak and mean gradient of 25±9 and 14±5 (group 1) versus 40±17 and 22±11 (group 2); both p=0.1.
Conclusion: Using sutureless prosthesis decreases bypass and x-clamp times and results in similar clinical early outcomes compared to stented valves. At follow-up sutureless prosthesis have better hemodynamic performance with decreased gradients, greater effective orifice area and may improve long term outcome.
