title: Efficacy of sutureless aortic valves in minimally invasive cardiac surgery: an evolution of the surgical technique.
abstract: BACKGROUND
  Sutureless aortic valve prostheses have the potential of shortening surgical time, but if this results in improved clinical outcome remains to be determined. The aim of this study was to compare the outcome of patients undergoing conventional vs. minimally invasive AVR, with either a stented or sutureless bioprosthesis.
  
  
  METHODS
  From 2007 to 2015, 627 patients underwent elective isolated AVR and were divided into three groups: patients who underwent sutureless-AVR via J sternotomy (group A, N.=206) and patients who underwent stented-AVR via J sternotomy (group B, N.=247) or full-sternotomy (group C, N.=174).
  
  
  RESULTS
  Patients in group A were significantly older than groups B and C (77±5 vs. 74±7 and 70±8 years; P<0.001). Aortic cross-clamp and cardiopulmonary bypass times were shorter in group A than in groups B and C. As expected, aortic cross-clamp time was prolonged in group B as compared to groups A and C (60±18 vs. 36±10 and 54±16 min; P<0.001). After multivariate adjustment, minimally invasive AVR resulted in significantly fewer postoperative complications in terms of drainage bleeding and the need for blood transfusions (385±287 vs. 500±338 mL, P=0.006; and 1.3±2.1 vs. 1.8±2.6 IU, P=0.001, respectively). No differences in postoperative outcomes were observed among groups.
  
  
  CONCLUSIONS
  The minimally invasive approach confers a protective effect against bleeding complications, but it is time-consuming. The use of sutureless valves is associated with significantly shorter surgical times compared with stented bioprostheses. In addition, no differences in mortality were observed among groups, and patients who received a sutureless valve, though significantly older, showed a better clinical outcome than patients who received a stented valve.
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Pfeiffer
authors.affiliation: Department of Cardiac Surgery, University Hospital, Münster, Germany.
authors.forename: Angelo M
authors.initials: AM
authors.lastname: Dell'aquila
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Vogt
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Jurij M
authors.initials: JM
authors.lastname: Kalisnik
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Sirch
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany - giuseppe.santarpino@klinikum-nuernberg.de.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001803:Blood Transfusion; D002983:Clinical Competence; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D000071062:Sutureless Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome