Sutureless valves and the quality of perfusion: towards a goal directed aortic valve replacement

BACKGROUND: Aim of this study was to assess the potential differences in respecting the principles of goal-directed perfusion between aortic valve replacement with sutureless vs. conventional stented bioprostheses. METHODS: Data from 94 consecutive patients undergoing aortic valve replacement with Perceval sutureless valve, with or without concomitant coronary artery bypass grafting, were compared to a contemporary cohort of 116 patients receiving conventional stented bioprostheses. Propensity score matching was used to reduce selection bias. Flow-dependent estimate of oxygen delivery and carbon dioxide production were compared in accordance to the principles of goal directed perfusion. Hospital outcomes were assessed as well. RESULTS: Propensity score matching resulted in 39 pairs with similar characteristics and operative risk. Cross-clamping time (41.6 +/- 20.6 vs. 89.6 +/- 48.2; P<0.001) and cardiopulmonary bypass time (66.9 +/- 29.4 vs. 121.2 +/- 56.6, P<0.001) were shorter in Perceval patients. Flow-dependent parameters were significantly better in Perceval patients (peak VCO(2)i P=0.010; nadir VO(2)i P=0.035; nadir DO(2)i/VCO(2)i P=0.015; peak RQ P=0.020) and therefore goal-directed perfusion principles were met more frequently (all P<0.001). Peak lactates were higher in controls (P=0.001), as well as number of patients receiving transfusions during CPB (P=0.044). QualyP Score was also higher in controls (P<0.001). Perceval patients experienced reduced postoperative bleeding, had a lower incidence of surgical revisions and transfusions. Duration of ventilation was longer in controls. CONCLUSIONS: The use of sutureless valves significantly reduces cardiopulmonary bypass and cross-clamping times and contributes to achieve a goal-directed perfusion. This results in better perfusion quality, with a positive clinical impact.