title: Sutureless prostheses and less invasive aortic valve replacement: just an issue of clamping time?
abstract: BACKGROUND
  Recently, sutureless aortic bioprostheses have been increasingly adopted to facilitate minimally invasive aortic valve replacement. We aimed at evaluating the impact of the transition from conventional bioprostheses to the routine use of the 3f Enable prosthesis (Medtronic ATS Medical, Minneapolis, MN) for aortic valve replacement through ministernotomy.
  
  
  METHODS
  Between November 2009 and November 2012, 83 consecutive minimally invasive aortic valve replacement procedures were performed in our institution by the same surgeon through an upper T-shaped ministernotomy. The earliest 42 patients (group A) received a conventional bioprosthesis, and the later 41 patients (group B) received the sutureless 3f Enable valve. Aortic clamping and cardiopulmonary bypass times, early outcomes, and valve hemodynamics were compared.
  
  
  RESULTS
  There was no statistical intergroup difference in baseline characteristics. In-hospital mortality was 1% (a single nonvalve-related death). Average aortic clamping times in group A and group B were, respectively, 85 ± 17 and 47 ± 11 minutes (p < 0.0001); the cardiopulmonary bypass time was 108 ± 21 and 69 ± 15 minutes, respectively (p < 0.0001). There were three paravalvular leakages in group A (grade I) and four in group B (two grade I, and two grade II); three pacemaker implantations occurred in group B (p = 0.07); mean transvalvular gradient at discharge was 16.9 ± 9.1 mm Hg in group A and 11.4 ± 4.3 mm Hg in group B (p = 0.0007). During follow-up (average 25.5 ± 12.9 months), one structural valve deterioration was registered in group A, and was treated with a valve-in-valve procedure.
  
  
  CONCLUSIONS
  In our initial experience, the sutureless 3f Enable technology significantly reduced the clamping and cardiopulmonary bypass times, as well as the mean transvalvular gradient in aortic valve replacement through ministernotomy.
authors.affiliation: Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Priest en Jarez, France. Electronic address: marco.vola@univ-st-etienne.fr.
authors.forename: Marco
authors.initials: M
authors.lastname: Vola
authors.affiliation: Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Priest en Jarez, France.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Campisi
authors.affiliation: Cardiology Unit, University Hospital St-Etienne, St-Priest en Jarez, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Gerbay
authors.affiliation: Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Priest en Jarez, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Fuzellier
authors.affiliation: Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Priest en Jarez, France.
authors.forename: Iness
authors.initials: I
authors.lastname: Ayari
authors.affiliation: Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Priest en Jarez, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Favre
authors.affiliation: Anesthesiology and Reanimation Department, University Hospital St-Etienne, St-Priest en Jarez, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Faure
authors.affiliation: Anesthesiology and Reanimation Department, University Hospital St-Etienne, St-Priest en Jarez, France.
authors.forename: Jerôme
authors.initials: J
authors.lastname: Morel
authors.affiliation: Cardiovascular Surgery Unit, University Hospital St-Etienne, St-Priest en Jarez, France.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005602:France; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D011474:Prosthesis Design; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013537:Sutures