title: Sutureless aortic valves: who is the right patient?
abstract: OBJECTIVE
  Sutureless aortic valve replacement (AVR) has emerged as an alternative to traditional AVR for patients with aortic stenosis who present a higher surgical risk, such as the elderly, or those with small or highly calcified aortic roots. With transcatheter aortic valve implantation - the other major AVR alternative - being used in increasingly lower-risk patients, the place of sutureless valves in the AVR landscape needs to be defined. In this review, we discuss recent data and expert opinion as it pertains to the subject of sutureless AVR.
  
  
  RESULTS
  Several recent studies have evaluated the performance of sutureless valves in a variety of clinical contexts, including minimally invasive operations and high-risk surgical procedures. The optimal surgical technique for sutureless AVR has been refined through the publication of several reports addressing technical considerations. Reduction in operative times represents the main advantage of sutureless valves over conventional surgical prostheses, and the possibility of complete annular decalcification - and hence a reduced incidence of paravalvular leak - is the primary advantage over TAVI.
  
  
  CONCLUSIONS
  Sutureless valves have emerged as an attractive option for high-risk patients or for complex surgeries where a minimization of bypass time is critical. However, there is limited data regarding long-term outcomes, durability or reoperation.
authors.affiliation: Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Amine
authors.initials: A
authors.lastname: Mazine
authors.forename: Christopher
authors.initials: C
authors.lastname: Bonneau
authors.forename: Dimos
authors.initials: D
authors.lastname: Karangelis
authors.forename: Bobby
authors.initials: B
authors.lastname: Yanagawa
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
authors.forename: Daniel
authors.initials: D
authors.lastname: Bonneau
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000639:trends; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome