REDO Aortic Valve Replacement: The Sutureless Approach

Background and aim of the study: The study aim was to report the results of a single-center cohort of patients who underwent aortic valve replacement (AVR) with a sutureless prosthesis in case of cardiac reoperation (REDO). Methods: Between March 2010 and December 2011, a total of 83 patients underwent AVR with the Perceval (TM) S sutureless aortic bioprosthesis (Sorin Biomedica Cardio Srl, Saluggia, Italy) at the authors' institution. Thirteen of these patients (six males, seven females; mean age 75.2 +/- 5.6 years) had previously undergone cardiac surgery and represented the study population. Preoperative, periprocedural and echocardiographic parameters, as well as clinical outcomes, were analyzed for all patients. Results: The primary procedure was AVR, using a bioprosthesis in six patients (46%) and coronary artery bypass grafting in seven (54%). The logistic EuroSCORE was 19.4 +/- 10.7%. Surgery was always performed via a full sternotomy; the mean implanted valve size was 23.6 +/- 1.3 mm (the previous valve size was 23.2 +/- 3.2 mm; p = 0.66). The mean cross-clamp time was 44 +/- 16 min, and the mean intensive care unit stay was 3.3 +/- 2.3 days. No intraoperative or in-hospital deaths occurred, and all patients were alive at a mean follow up of 8.5 months. Two postoperative events included transient ischemic attack in one patient, and the need for pacemaker implantation in one patient. On echocardiographic evaluation, no patient showed signs of paraprosthetic leak. The mean transvalvular gradient was 10.3 +/- 1.5 mmHg. Conclusion: Use of the Perceval S sutureless AVR offers a fast and safe procedure, even in high-risk REDO surgery, providing a good hemodynamic performance with excellent clinical recovery, demonstrated at a follow up of six months. Although the sample size was limited, the results were encouraging and support the use of sutureless valves in the frame of REDO surgery for aortic valve disease.