title: Sutureless Aortic Valve: Early and Mid-Term Results at a Single Center.
abstract: Background: Prolonged life expectancy has increased the number of elderly high risk patients referred for surgical aortic valve replacement (AVR). These referred high risk patients may benefit from sutureless bioprosthesis procedures which reduce mortality and morbidity.
  
  
  OBJECTIVE
  To present our initial experience with sutureless aortic bioprotheses, including clinical and echocardiographic results, in elderly high risk patients referred for AVR.
  
  
  METHODS
  Forty patients (15 males, mean age 78 ± 7 years) with symptomatic severe aortic stenosis underwent AVR with the 3F Enable or Perceval sutureless bioprosthesis during the period December 2012 to May 2014. Mean logistic EuroScore was 10 ± 3%. Echocardiography was performed preoperatively, intraoperatively, at discharge and at follow-up.
  
  
  RESULTS
  There was no in-hospital mortality. Nine patients (22%) underwent minimally invasive AVR via a right anterior mini-thoracotomy and one patient via a J-incision. Four patients underwent concomitant coronary aortic bypass graft, two needed intraoperative repositioning of the valve, one underwent valve exchange due to inappropriate sizing, three (7.5%) had a perioperative stroke with complete resolution of neurologic symptoms, and one patient (2.5%) required permanent pacemaker implantation due to complete atrioventricular block. Mean preoperative and postoperative gradients were 44 ± 14 and 13 ± 5 mmHg, respectively. At follow-up, 82% of patients were in New York Heart Association functional class I and II.
  
  
  CONCLUSIONS
  Sutureless AVR can be used safely in elderly high risk patients with relatively low morbidity and mortality. The device can be safely implanted via a minimally invasive incision. Mid-term hemodynamic results are satisfactory, demonstrating significant clinical improvement.
authors.forename: Amjad
authors.initials: A
authors.lastname: Shalabi
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
authors.forename: Amihai
authors.initials: A
authors.lastname: Shinfeld
authors.forename: Rafael
authors.initials: R
authors.lastname: Kuperstein
authors.forename: Alexander
authors.initials: A
authors.lastname: Kogan
authors.forename: Alexander
authors.initials: A
authors.lastname: Lipey
authors.forename: Eyal
authors.initials: E
authors.lastname: Nachum
authors.forename: Dan
authors.initials: D
authors.lastname: Spiegelstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012720:Severity of Illness Index; D013908:Thoracotomy / Q000379:methods