title: Sutureless aortic valve implantation through an upper v-type ministernotomy: an innovative approach in high-risk patients.
abstract: OBJECTIVE
  Aortic valve replacement in minimally invasive approach has shown to improve clinical outcomes even with a prolonged cardiopulmonary bypass and aortic cross-clamp (ACC) time. Sutureless aortic valve implantation may ideally shorten operative time. We describe our initial experience with the sutureless 3f Enable (Medtronic, Inc, ATS Medical, Minneapolis, MN USA) aortic bioprosthesis implanted in minimally invasive approach in high-risk patients.
  
  
  METHODS
  Between May 2010 and May 2011, thirteen patients with severe aortic stenosis underwent aortic valve replacement with the 3f Enable bioprosthesis through an upper V-type ministernotomy interrupted at the second intercostal space. The mean ± SD age was 77 ± 3.9 years (range, 72-83 years), 10 patients were women, and the mean ± SD logistic EuroSCORE was 15% ± 13.5%. Echocardiography was performed preoperatively, at postoperative day 1, at discharge, and at follow-up. Clinical data, adverse events, and patient outcomes were recorded retrospectively. The median follow-up time was 4 months (interquartile range, 2-10 months).
  
  
  RESULTS
  Most of the implanted valves were 21 mm in diameter (19-25 mm). The CPB and ACC times were 100.2 ± 25.3 and 66.4 ± 18.6 minutes. At short-term follow-up, the mean ± SD pressure gradient was 14 ± 4.9 mm Hg; one patient showed trivial paravalvular leakage. No patients died during hospital stay or at follow-up.
  
  
  CONCLUSIONS
  The 3f Enable sutureless bioprosthesis implanted in minimally invasive approach through an upper V-type ministernotomy is a feasible, safe, and reproducible procedure. Hemodynamic and clinical data are promising. This innovative approach might be considered as an alternative in high-risk patients. Reduction of CPB and ACC time is possible with increasing of experience and sutureless evolution of actual technology.
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy. gioconci@libero.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Concistrè
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiaramonti
authors.forename: Pierandrea
authors.initials: P
authors.lastname: Farneti
authors.forename: Stefano
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: Egidio
authors.initials: E
authors.lastname: Varone
authors.forename: Marco
authors.initials: M
authors.lastname: Solinas
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass / Q000379:methods; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D061646:Operative Time; D011474:Prosthesis Design; D018570:Risk Assessment; D012720:Severity of Illness Index; D056346:Sternotomy / Q000379:methods*; D015996:Survival Rate; D013537:Sutures; D016896:Treatment Outcome