title: Sutureless Valve Implantation in Sievers Type 0 Bicuspid Annuli: A Word of Caution.
abstract: OBJECTIVE
  We describe a series of 3f Enable sutureless prostheses implanted in bicuspid valves.
  
  
  METHODS
  Between March 2011 and April 2014, five patients with Sievers type 0 bicuspid valves were selected to receive the sutureless 3f Enable prosthesis . Exclusion criteria were: intraoperative calibration of the aortic annulus >27 mm, left ventricle ejection fraction <50%, age <70 years.
  
  
  RESULTS
  All the implantations could be performed without the necessity to re-deploy the prosthesis . The perioperative transesophageal echocardiogragram detected two moderate paravalvular leakages (PVL) in two patients who received a large size of prosthesis (25 and 27 mm, respectively). The two leakages, at a follow-up of 32 and 24 months, respectively, increased to grade II and II +. No PVL appeared in the other three patients.
  
  
  CONCLUSIONS
  This experience should warn about the inadequate performance of the 3f Enable valve in Sievers type 0 large aortic bicuspid annuli. In this subset any minor intraoperative residual leakage should not be accepted.
authors.affiliation: Department of Cardiovascular, Cardiac Surgery Unit, University Hospital, St. Etienne, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Vola
authors.affiliation: Department of Cardiovascular, Cardiology Unit, University Hospital, St. Etienne, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Guichard
authors.affiliation: Department of Cardiovascular, Cardiac Surgery Unit, University Hospital, St. Etienne, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Fuzellier
authors.affiliation: Department of Cardiovascular, Cardiology Unit, University Hospital, St. Etienne, France.
authors.forename: Benjamain
authors.initials: B
authors.lastname: Haber
authors.affiliation: Department of Cardiovascular, Cardiac Surgery Unit, University Hospital, St. Etienne, France.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Campisi
authors.affiliation: Department of Cardiovascular, Cardiology Unit, University Hospital, St. Etienne, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Gerbay
authors.affiliation: Department of Cardiovascular, Cardiac Surgery Unit, University Hospital, St. Etienne, France.
authors.forename: Vito Giovanni
authors.initials: VG
authors.lastname: Ruggieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D013318:Stroke Volume; D013537:Sutures