Sutureless implantation of the perceval s aortic valve prosthesis through right anterior minithoracotomy.
BACKGROUND
Many new, less invasive strategies are proposed for aortic valve operation in elderly patients. Rapid deployment sutureless aortic valve prosthesis has been recently introduced. We analyzed our experience with a sutureless valve implanted through a minimally invasive approach.


METHODS
A retrospective observational study with prospectively registered data was conducted on 137 patients undergoing aortic valve replacement through a right anterior minithoracotomy. Between April 2011 and January 2013, 137 consecutive patients underwent aortic valve replacement with a recently introduced, rapid deployment, sutureless pericardial valve in minithoracotomy access (47 men; mean age, 76.6 ± 7.1 years). There were 35 obese patients with a body mass index of more than 30 kg/m(2). Mean logistic EuroSCORE I was 10.0; 74 (54%) patients were in New York Heart Association functional class III and IV. In all, 19 (13.9%), 45 (32.8%), and 73 (53.3%) patients received 21-, 23-, and 25-mm valve prostheses, respectively.


RESULTS
The mean aortic cross-clamp and cardiopulmonary bypass times were 59.3 ± 19 min and 92.3 ± 27 min, respectively. No operative mortality occurred. Median stay in the intensive care unit was 1 day, with assisted ventilation necessary for a median of 6 hours. Three cases of postoperative ischemic stroke were observed (1 patient with a previous history of an ischemic cerebral event). Median hospital length of stay was 6 days.


CONCLUSIONS
A sutureless valve for minimally invasive aortic valve replacement is a feasible, effective, and safe tool. Ultimately amplifying indications for less invasive aortic valve replacement in a high surgical risk subset of patients, it can become a valid alternative for transcatheter aortic valve implantation.
Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy. Electronic address: drgilmanov@hotmail.it.
Daniyar
D
Gilmanov
Antonio
A
Miceli
Stefano
S
Bevilacqua
Pierandrea
P
Farneti
Marco
M
Solinas
Matteo
M
Ferrarini
Mattia
M
Glauber
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013536:Suture Techniques; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome
35; AV; AVR; BMI; CAD; CC; CPB; CVVH; EuroSCORE I; European System for Cardiac Operative Risk Evaluation (version I); ICU; MIAVR; NYHA; New York Heart Association; RAMT; SD; TAVI; aortic cross-clamping; aortic valve replacement; atrioventricular; body mass index; cardiopulmonary bypass; continuous venovenous hemodialysis; coronary artery disease; intensive care unit; minimally invasive aortic valve replacement; right anterior minithoracotomy; standard deviation; transcatheter aortic valve implantation