title: Two alternative sutureless strategies for aortic valve replacement: a two-center experience.
abstract: OBJECTIVE
  Important comorbid conditions in patients referred for aortic valve replacement (AVR) require less invasive strategies. We describe our initial experience with the Perceval S (Sorin Group, Saluggia, Italy) and 3f Enable (Medtronic, Minneapolis, MN USA) sutureless aortic bioprostheses.
  
  
  METHODS
  We compared intraoperative data, postoperative clinical outcomes, and echocardiographic results from patients receiving a Perceval S (P group; n = 97) or a 3f Enable (E group; n = 32) prosthesis in two cardiac surgery departments (Nuremberg, Germany, and Massa, Italy).
  
  
  RESULTS
  Baseline patient characteristics were similar in both groups, except for mean ± SD body surface area (P group = 2.01 ± 2.9 m, E group = 1.83 ± 3.8 m; P < 0.001). Sixty-five patients (67%) in the P group and 19 patients (59.5%) in the E group (P = 0.22) underwent minimally invasive AVR with either ministernotomy or right anterior minithoracotomy approach. Concomitant procedures were performed in 37 patients (38%) in the P group and 9 patients (28%) in the E group (P = 0.56). In-hospital mortality was 2%. The mean ± SD prosthesis diameter was 23.5 ± 1.4 mm (P group) compared with 22.1 ± 2 mm (E group) (P < 0.001). In isolated AVR, aortic cross-clamp time was 36 ± 12.7 minutes in the P group and 66 ± 18 minutes in the E group (P < 0.001). At a mean ± SD follow-up of 8.3 ± 4.5 months, survival was 97% (one death in the P group). In five patients (P group = 1, E group = 4), a moderate paravalvular leak was present (P = 0.013). The mean ± SD transvalvular gradient was 9.1 ± 3.3 mm Hg with the Perceval S and 11.2 ± 5.2 mm Hg with the 3f Enable (P = 0.017).
  
  
  CONCLUSIONS
  Aortic valve replacement with sutureless aortic bioprosthesis is feasible, also with a minimally invasive approach. The Perceval S showed lower operative times and moderate paravalvular leaks and lower mean transvalvular gradients than did the 3f Enable, related to the larger diameter of the Perceval S implanted. Both prostheses showed an excellent hemodynamic performance. This new technology needs long-term follow-up.
authors.affiliation: From the *Department of Cardiac Surgery - Klinikum Nürnberg, Nuremberg, Germany; and †Department of Cardiac Surgery, Ospedale del Cuore "G. Pasquinucci," Fondazione Monasterio-CNR, Massa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Concistrè
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.forename: Steffen
authors.initials: S
authors.lastname: Pfeiffer
authors.forename: Pierandrea
authors.initials: P
authors.lastname: Farneti
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiaramonti
authors.forename: Marco
authors.initials: M
authors.lastname: Solinas
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015996:Survival Rate; D013537:Sutures; D016896:Treatment Outcome