title: Sutureless aortic bioprosthesis valve implantation and bicuspid valve anatomy: an unsolved dilemma?
abstract: Interest is growing in the clinical use of sutureless (SU) valves. However, indications in some anatomical sub-settings, like bicuspid aortic valves (BAV), have been so far limited. We discuss herein our initial experience with the implantation of the 3f Enable SU bioprosthesis in patients with a BAV. Patients with a BAV were selected in our unit between March 2011 and September 2014 for a SU 3f Enable valve implantation. Twenty of the 198 patients who underwent a 3f Enable valve implantation in our unit had a BAV. Procedural success was 100 %, but reclamping was necessary in one (5 %) case. Median size of implanted bioprosthesis was 23 mm. After a mean follow-up of 13.8 ± 10.7 months, survival was 100 %. Two patients (10 %) showed an immediate grade 1 paravalvular leak (PVL) that progressed to grade 2 and 3+ (moderate/severe), respectively, during follow-up. Type of bicuspidy (Sievers classification) in these two patients was 0 and intraoperatively aortic annuli admitted the 25 mm calibrator. Among the 18 patients without PVL, no one had a type 0 large BAV. At 1 year, implantation of the 3f Enable SU bioprosthesis appears to be safe in patients with BAV type I and II, while in type 0 use of the SU valve seems to be safe only if the annular diameter is <25 mm. Larger studies are necessary to confirm our findings in order to clarify the indications for SU technology in the subset of bicuspid patients.
authors.affiliation: Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France. marco.vola@chu-st-etienne.fr.|Service de Chirurgie Cardiovasculaire, Pôle Cardiovasculaire, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, 42055, Saint-Etienne Cedex, France. marco.vola@chu-st-etienne.fr.
authors.forename: Marco
authors.initials: M
authors.lastname: Vola
authors.affiliation: Cardiology Unit, Cardiovascular Department, University Hospital, St. Etienne, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Guichard
authors.affiliation: Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Campisi
authors.affiliation: Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Fuzellier
authors.affiliation: Cardiology Unit, Cardiovascular Department, University Hospital, St. Etienne, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Gerbay
authors.affiliation: Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Doguet
authors.affiliation: Cardiology Unit, Cardiovascular Department, University Hospital, St. Etienne, France.
authors.forename: Karl
authors.initials: K
authors.lastname: Isaaz
authors.affiliation: Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France.
authors.forename: Kasra
authors.initials: K
authors.lastname: Azarnoush
authors.affiliation: Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.affiliation: Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France.
authors.forename: Vito Giovani
authors.initials: VG
authors.lastname: Ruggieri
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D000071062:Sutureless Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic valve replacement; Bicuspidy; Bioprosthesis; Sutureless; TAVI