title: Sutureless aortic valve replacement: a Canadian multicentre study.
abstract: BACKGROUND
  Sutureless aortic valve replacement (AVR) has recently been introduced as an alternative to standard AVR in elderly high-risk surgical patients. The purpose of this study was to report the early Canadian experience with sutureless AVR.
  
  
  METHODS
  A Canadian multicenter study included 215 consecutive patients from 6 centres who underwent sutureless AVR using the Perceval S bioprosthesis (Sorin Group, Saluggia, Italy) between June 2011 and May 2013. Perioperative clinical and echocardiographic outcomes were assessed in all patients.
  
  
  RESULTS
  Mean age was 79 ± 6 years, and 116 patients (54%) were women. Concomitant procedures included coronary artery bypass grafting in 86 patients (40%), multiple valve procedures in 24 (11%) patients, and septal myectomy in 9 (4%) patients. A full sternotomy was used in 173 cases (80%), a minithoracotomy in 23 (11%) cases, and a partial sternotomy in 19 (9%) cases. Nineteen cases (9%) were redo procedures. For isolated AVR, mean aortic cross-clamp time was 41 ± 12 minutes. In-hospital mortality occurred in 9 patients (4%). No postoperative valve migration was reported. A total of 37 patients (17%) underwent postoperative implantation of a permanent pacemaker, including 20 patients (9%) who had complete atrioventricular block. Postoperative stroke occurred in 7 patients (3%). Echocardiographic evaluation demonstrated well-seated valves with no significant (2+) valvular or paravalvular aortic insufficiency and a mean aortic gradient of 13 ± 6 mm Hg.
  
  
  CONCLUSIONS
  Sutureless AVR using the Perceval S prosthesis is safe and reproducible and results in short operative times. Echocardiographic results are encouraging, with low gradients and no paravalvular aortic insufficiency. However, in this series, sutureless AVR was associated with a high risk of permanent pacemaker implantation.
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebéc, Canada.
authors.forename: Amine
authors.initials: A
authors.lastname: Mazine
authors.affiliation: Department of Cardiac Surgery, Southlake Regional Health Center, McMaster University, Newmarket, Ontario, Canada; Department of Cardiac Surgery, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Teoh
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebéc, Canada.
authors.forename: Ismail
authors.initials: I
authors.lastname: Bouhout
authors.affiliation: Department of Cardiac Surgery, Trillium Health Center, Mississauga, Ontario, Canada.
authors.forename: Gopal
authors.initials: G
authors.lastname: Bhatnagar
authors.affiliation: Department of Cardiac Surgery, New Brunswick Heart Center, Saint John, New Brunswick, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Pelletier
authors.affiliation: Department of Cardiac Surgery, Institut Universitaire de Cardiologie de Québec/Hôpital Laval, Québec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebéc, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Demers
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebéc, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebéc, Canada. Electronic address: denis.bouchard@icm-mhi.org.
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome