title: Early and intermediate outcome after aortic valve replacement with a sutureless bioprosthesis: Results of a multicenter study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the outcome of aortic valve replacement with the sutureless Perceval S aortic valve bioprosthesis (Sorin Biomedica Cardio Srl, Saluggia, Italy).
  
  
  METHODS
  This is a retrospective analysis of 314 patients (mean age, 77.9 ± 5.0 years, mean European System for Cardiac Operative Risk Evaluation II, 9.0% ± 7.6%) who underwent aortic valve replacement with the Perceval S valve with (94 patients) or without (220 patients) concomitant coronary artery bypass surgery at 5 European centers.
  
  
  RESULTS
  The Perceval S valve was successfully implanted in all but 1 patient (99.7%). The mean aortic crossclamping time was 43 ± 20 minutes (isolated procedure, 39 ± 15 minutes; concomitant coronary surgery, 52 ± 26 minutes). Severe paravalvular leak occurred in 2 patients (0.6%). In-hospital mortality was 3.2% (1.4% after isolated procedure and 7.4% after concomitant coronary surgery). In-hospital mortality was 2.8% and 4.0% among patients with a European System for Cardiac Operative Risk Evaluation II less than 10% and 10% or greater, respectively (P = .558). Octogenarians had slightly higher in-hospital mortality (5.2% vs 2.0%, P = .125; after isolated procedure: 2.7% vs 0.7%, P = .223; after concomitant coronary surgery: 9.5% vs 5.8%, P = .491) compared with younger patients. Full sternotomy did not increase the in-hospital mortality risk compared with ministernotomy or minithoracotomy access (1.3% vs 1.4%, when adjusted for baseline covariates: P = .921; odds ratio, 0.886; 95% confidence interval, 0.064-12.346). One-year survival was 90.5%. Freedom from valve-related mortality, stroke, endocarditis, and reoperation was 99.0%, 98.1%, 99.2%, and 98.3%, respectively.
  
  
  CONCLUSIONS
  The sutureless Perceval S valve is associated with excellent early survival in high-risk patients, particularly among those undergoing an isolated procedure. Further studies are needed to prove the durability of this bioprosthesis.
authors: Cardiac Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy. Electronic address: antonio.rubino@hotmail.com.
authors: Antonino S
authors: AS
authors: Rubino
authors: Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany.
authors: Giuseppe
authors: G
authors: Santarpino
authors: Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
authors: Herbert
authors: H
authors: De Praetere
authors: Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
authors: Keiichiro
authors: K
authors: Kasama
authors: Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors: Magnus
authors: M
authors: Dalén
authors: Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors: Ulrik
authors: U
authors: Sartipy
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Jarmo
authors: J
authors: Lahtinen
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Jouni
authors: J
authors: Heikkinen
authors: Cardiac Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
authors: Wanda
authors: W
authors: Deste
authors: Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany.
authors: Francesco
authors: F
authors: Pollari
authors: Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors: Peter
authors: P
authors: Svenarud
authors: Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
authors: Bart
authors: B
authors: Meuris
authors: Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany.
authors: Theodor
authors: T
authors: Fischlein
authors: Cardiac Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
authors: Carmelo
authors: C
authors: Mignosa
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Fausto
authors: F
authors: Biancari
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D056346:Sternotomy; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome