title: Sutureless Aortic Valve Replacement via Partial Sternotomy.
abstract: OBJECTIVE
  : For elderly patients with symptomatic aortic valve stenosis, aortic valve replacement with tissue valves is still the treatment of choice. Stentless valves were introduced to clinical practice for better hemodynamic features as compared with stented tissue valves. However, the implantation is more complex and time demanding, especially in minimal invasive aortic valve replacement. We present our clinical data on 22 patients having received a sutureless ATS 3f Enable aortic bioprosthesis via partial upper sternotomy.
  
  
  METHODS
  : The procedure was performed using CPB with cardioplegic arrest. After resection of the stenotic aortic valve and debridement of the annulus, the valve was inserted and released. Mean age was 79 years, and mean logistic Euroscore was 13. Subvalvular myectomy was performed in two patients. Prosthetic valve sizes were 19 mm (n = 1), 21 mm (n = 7), 23 mm (n = 6), 25 mm (n = 6), and 27 mm (n = 2).
  
  
  RESULTS
  : Implantation of the valve required 10 ± 6 minutes. Cardiopulmonary bypass and aortic crossclamp time were 87 ± 16 and 55 ± 11 minutes, respectively. Early mortality (<90 days) was 9% (2 patients). No paravalvular leakage was detected intraoperatively or in follow-up echocardiography. The mean transvalvular gradients were 9 ± 6 mm Hg at discharge and 8 ± 2 mm Hg at 1-year follow-up.
  
  
  CONCLUSIONS
  : Sutureless valve implantation via partial sternotomy is feasible and safe with the ATS 3f Enable bioprosthesis. Reduction of cardiopulmonary bypass and aortic crossclamp time seems possible with increasing experience. Hemodynamic data are very promising with low gradients at discharge and after 12 month. Sutureless valve implantation via minimal invasive access may be an alternative treatment option for elderly patients with high comorbidity.
authors.affiliation: From the Department of Thoracic and Cardiovascular Surgery, JWGoethe University Hospital, Frankfurt am Main, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Martens
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.forename: Anja
authors.initials: A
authors.lastname: Ploss
authors.forename: Sami
authors.initials: S
authors.lastname: Sirat
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Miskovic
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.forename: Mirko
authors.initials: M
authors.lastname: Doss