Sutureless Versus Stented Valve in Aortic Valve Replacement in Patients With Small Annulus.

Ann Thorac Surg 2016 Jul 23;102(1):118-22. Epub 2016 Mar 23.

Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel. Electronic address:

Background: Aortic valve replacement, particularly in elderly patients with small aortic annulus, could lead to patient-prosthesis mismatch. Sutureless bioprosthesis could be an ideal solution for these patients. We compared results of aortic valve replacement with sutureless versus stented bioprosthetic valves.

Methods: Of the 63 patients undergoing aortic valve replacement with sutureless bioprosthesis between 2011 and 2014 in our department, 22 (20 women, 77 ± 6 years) had a small annulus less than 21 mm (sutureless group). They were matched for sex, age, body surface area, and left ventricular ejection fraction with 22 patients (20 women, 79 ± 6 years) undergoing stented bioprosthesis valve replacement (stented group). Body mass index and body surface area were 28 ± 5 kg/m(2) and 28 ± 3 kg/m(2) (p = 0.9), 1.6 ± 0.2 m(2) and 1.6 ± 0.1 m(2) (p = 0.9), in the sutureless and stented groups, respectively. Logistic EuroSCOREs were similar between groups.

Results: Postoperative peak transvalvular gradient was lower in the sutureless group (15 ± 7 mm Hg versus 20 ± 11 mm Hg; p = 0.02). The indexed effective orifice area was greater in the sutureless group (1.12 ± 0.2 cm(2)/m(2) versus 0.82 ± 0.1 cm(2)/m(2); p < 0.05). Aortic cross-clamp and cardiopulmonary bypass times were 47 ± 21 and 67 ± 15 minutes, respectively (p < 0.05) in the sutureless group versus 70 ± 22 and 85 ± 21 minutes, respectively (p = 0.02) in the stented group. Intensive care unit stay, hospitalization, and major complications were not significantly different between groups. At follow-up, regression of left ventricular hypertrophy was better in the sutureless group (93 ± 21 g/m(2) versus 106 ± 14 g/m(2); p = 0.02).

Conclusions: Sutureless bioprosthetic valves demonstrate improved hemodynamic performance compared with stented valves in elderly patients with small aortic annulus, providing better regression of left ventricular hypertrophy and decreased rates of patient-prosthesis mismatch. Aortic cross-clamp and cardiopulmonary bypass times are also decreased.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2016.01.003DOI Listing
July 2016
9 Reads
1 Citation
3.850 Impact Factor

Publication Analysis

Top Keywords

valve replacement
20
aortic valve
16
sutureless group
12
patients small
8
women years
8
small annulus
8
body surface
8
replacement sutureless
8
sutureless bioprosthesis
8
sutureless
8
surface area
8
sutureless versus
8
versus stented
8
aortic
6
valve
6
patients
5
replacement
5
stented
5
group body
4
undergoing stented
4

Similar Publications