title: Sutureless aortic valve replacement with the Trilogy Aortic Valve System: multicenter experience.
abstract: OBJECTIVE
  To evaluate the modular sutureless Arbor Trilogy Aortic Valve System (Arbor Surgical Technologies, Irvine, Calif), designed for minimally invasive aortic valve replacement.
  
  
  METHODS
  In a prospective multicenter study, 32 patients with severe aortic valve stenosis underwent aortic valve replacement with the Trilogy valve between 2006 and 2008. Concomitant coronary artery bypass grafting was performed in 6 patients. Transthoracic echocardiography was performed at baseline, at discharge, at 4 to 6 months, at 11 to 14 months, and annually thereafter.
  
  
  RESULTS
  Valve implantation was successful in 30 patients. The procedure was converted to conventional aortic valve replacement in 2 patients. Mean bypass time was 111 ± 42 minutes, and crossclamp time was 70 ± 23 minutes. Valve implantation took 21 ± 7 minutes. The transvalvular gradients at discharge were 10 ± 3 mm Hg (mean) and 20 ± 7 mm Hg (peak), and the effective orifice area was 1.9 ± 0.4 cm(2). At 2-year follow-up, gradients were 7 ± 3 mm Hg (mean) and 14 ± 4 mm Hg (peak), and the effective orifice area was 1.9 ± 0.3 cm(2). There was no intraoperative mortality: Two patients died of causes unrelated to the valve during follow-up. One redo aortic valve replacement was performed at 22 months for prosthetic valve endocarditis.
  
  
  CONCLUSIONS
  Sutureless aortic valve replacement is feasible and safe with the Trilogy System. After an initial learning curve, the modular valve design allows a more rapid and simple implantation compared with conventional stented tissue valves. The simplicity may also facilitate a greater adoption of minimally invasive aortic valve replacement by a broader spectrum of surgeons.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig, Braunschweig, Germany. i.breitenbach@web.de
authors.forename: Ingo
authors.initials: I
authors.lastname: Breitenbach
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Leo A
authors.initials: LA
authors.lastname: Bockeria
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sadowski
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.forename: Boguslaw
authors.initials: B
authors.lastname: Kapelak
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bartus
authors.forename: Ravil
authors.initials: R
authors.lastname: Muratov
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Harringer
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010865:Pilot Projects; D011446:Prospective Studies; D011474:Prosthesis Design; D012086:Reoperation; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome