title: Sutureless Versus Stented Valve in Aortic Valve Replacement in Patients With Small Annulus.
abstract: BACKGROUND
  Aortic valve replacement, particularly in elderly patients with small aortic annulus, could lead to patient-prosthesis mismatch. Sutureless bioprosthesis could be an ideal solution for these patients. We compared results of aortic valve replacement with sutureless versus stented bioprosthetic valves.
  
  
  METHODS
  Of the 63 patients undergoing aortic valve replacement with sutureless bioprosthesis between 2011 and 2014 in our department, 22 (20 women, 77 ± 6 years) had a small annulus less than 21 mm (sutureless group). They were matched for sex, age, body surface area, and left ventricular ejection fraction with 22 patients (20 women, 79 ± 6 years) undergoing stented bioprosthesis valve replacement (stented group). Body mass index and body surface area were 28 ± 5 kg/m(2) and 28 ± 3 kg/m(2) (p = 0.9), 1.6 ± 0.2 m(2) and 1.6 ± 0.1 m(2) (p = 0.9), in the sutureless and stented groups, respectively. Logistic EuroSCOREs were similar between groups.
  
  
  RESULTS
  Postoperative peak transvalvular gradient was lower in the sutureless group (15 ± 7 mm Hg versus 20 ± 11 mm Hg; p = 0.02). The indexed effective orifice area was greater in the sutureless group (1.12 ± 0.2 cm(2)/m(2) versus 0.82 ± 0.1 cm(2)/m(2); p < 0.05). Aortic cross-clamp and cardiopulmonary bypass times were 47 ± 21 and 67 ± 15 minutes, respectively (p < 0.05) in the sutureless group versus 70 ± 22 and 85 ± 21 minutes, respectively (p = 0.02) in the stented group. Intensive care unit stay, hospitalization, and major complications were not significantly different between groups. At follow-up, regression of left ventricular hypertrophy was better in the sutureless group (93 ± 21 g/m(2) versus 106 ± 14 g/m(2); p = 0.02).
  
  
  CONCLUSIONS
  Sutureless bioprosthetic valves demonstrate improved hemodynamic performance compared with stented valves in elderly patients with small aortic annulus, providing better regression of left ventricular hypertrophy and decreased rates of patient-prosthesis mismatch. Aortic cross-clamp and cardiopulmonary bypass times are also decreased.
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Amjad
authors.initials: A
authors.lastname: Shalabi
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Spiegelstein
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Leonid
authors.initials: L
authors.lastname: Sternik
authors.affiliation: Department of Cardiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Micha S
authors.initials: MS
authors.lastname: Feinberg
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kogan
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Shany
authors.initials: S
authors.lastname: Levin
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Orlov
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Nachum
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lipey
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel. Electronic address: ehud.raanani@sheba.health.gov.il.
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome