title: Sutureless aortic valve replacement in patients who have bicuspid aortic valve.
abstract: OBJECTIVE
  Bicuspid aortic valve (BAV) is generally considered to be a contraindication to sutureless aortic valve replacement (AVR). The aim of this study was to evaluate the feasibility and perioperative outcomes of this technique in patients with BAV.
  
  
  METHODS
  From June 2011 to January 2014, a total of 25 patients who underwent sutureless AVR had documented BAV. Thirteen patients (52%) had median sternotomy, and 12 patients (48%) a minimally invasive approach.
  
  
  RESULTS
  The study population included 17 (68%) men with a median age of 77.8 ± 5.4 years. The mean EuroSCORE II was 3.4% ± 2.6%. Concomitant procedures included coronary artery bypass grafting in 8 patients (32%), 2 AVRs (8%), 1 mitral valve repair (4%), 1 septal myomectomy (4%), and 1 atrial septal defect closure (4%). The mean transaortic valve gradient decreased from 49.4 ± 15.7, to 14.5 ± 5.4 mm Hg postoperatively. The mean aortic valve area increased from 0.78 ± 0.18, to 1.75 ± 0.43 cm(2) postoperatively. Five patients (20%) suffered from atrioventricular block that required permanent pacemaker implantation. Two patients (8%) suffered a stroke. No major paravalvular leakage occurred, and no postoperative valve migration. In-hospital mortality occurred in 1 patient (4%). The mean intensive care unit length of stay was 3 ± 2 days postoperatively.
  
  
  CONCLUSIONS
  This study demonstrates that a sutureless aortic valve can be deployed in patients with BAV without increasing the risk of paravalvular leakage. BAV should not be considered a contraindication to sutureless AVR.
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; University of Montreal, Montreal, Quebec, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Nguyen
authors.affiliation: University of Montreal, Montreal, Quebec, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Fortin
authors.affiliation: University of Montreal, Montreal, Quebec, Canada.
authors.forename: Amine
authors.initials: A
authors.lastname: Mazine
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; University of Montreal, Montreal, Quebec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; University of Montreal, Montreal, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; University of Montreal, Montreal, Quebec, Canada.
authors.forename: Ismail
authors.initials: I
authors.lastname: El Hamamsy
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; University of Montreal, Montreal, Quebec, Canada.
authors.forename: Yoan
authors.initials: Y
authors.lastname: Lamarche
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; University of Montreal, Montreal, Quebec, Canada. Electronic address: philippe.demers@icm-mhi.org.
authors.forename: Philippe
authors.initials: P
authors.lastname: Demers
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000002:abnormalities; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D005240:Feasibility Studies; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013537:Sutures
keywords: Perceval S; aortic valve; bicuspid aortic valve; bioprosthesis; replacement