title: Early single-center experience in sutureless aortic valve implantation in 120 patients.
abstract: OBJECTIVE
  The study objective was to evaluate the safety and efficacy of sutureless self-expanding nitinol stent-frame aortic valve prostheses made of equine pericardium implanted in patients with symptomatic aortic valve disease.
  
  
  METHODS
  We performed a retrospective analysis of 120 patients (mean age, 76.7 ± 5.9 years) who underwent isolated aortic valve replacement or in combination with other cardiovascular procedures. Preoperatively, Society of Thoracic Surgeons score was determined. Transthoracic echocardiography and clinical outcome evaluation were performed at the time of discharge and at 6, 12, and 18 months follow-up, respectively.
  
  
  RESULTS
  A total of 71 of 120 patients underwent isolated sutureless aortic valve replacement (mean aortic crossclamp time, 37 ± 11 minutes; mean bypass time, 62 ± 18 minutes). Coronary bypass grafting was performed in 30 patients. Overall mean Society of Thoracic Surgeons score was 14.8% ± 10%. Thirty-day mortality rate was 6.7% overall and 1.4% in stand-alone procedures. During a mean follow-up of 313 days, 3 more deaths occurred. The reoperation rate was 4.2%. Mean and peak transvalvular pressure gradients were 9 mm Hg (4-13 mm Hg) and 14 mm Hg (8-22 mm Hg) at discharge, respectively. In 8 patients (6.7%), permanent pacemaker implantation was necessary. No thromboembolic events or bleedings related to the bioprosthesis were observed.
  
  
  CONCLUSIONS
  In this large single-center experience with sutureless aortic valve replacement, the surgical procedure is shown to be safe and time-saving. In view of the excellent hemodynamic results and shortening of aortic crossclamp and bypass times, we notice advantages especially in high-risk patients. Minimally invasive access seems to be facilitated. The long-term durability of this prosthesis has yet to be determined.
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Oldenburg, Oldenburg, Germany.
authors.forename: Harald C
authors.initials: HC
authors.lastname: Eichstaedt
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Oldenburg, Oldenburg, Germany.
authors.forename: Jerry
authors.initials: J
authors.lastname: Easo
authors.affiliation: Department of Cardiology, Klinikum Oldenburg, Oldenburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Härle
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Oldenburg, Oldenburg, Germany. Electronic address: dapunt.otto@klinikum-oldenburg.de.
authors.forename: Otto E
authors.initials: OE
authors.lastname: Dapunt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000818:Animals; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001026:Coronary Artery Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D006736:Horses; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000497:Alloys; C013616:nitinol
keywords: 35; AVR; TEE; aortic valve replacement; transesophageal echocardiography