title: Sutureless aortic bioprosthesis.
abstract: Aortic valve replacement (AVR) is the treatment of choice for aortic valve disease, with excellent results reported in the short- and long-term follow-up. Due to the increasing number of patient comorbidities and older age, various technical alternatives have been developed such as transcatheter aortic valve implantation and, more recently, sutureless valve bioprostheses. For patients with very high surgical risk, transcatheter implantation is becoming the top therapeutic option. However, the percutaneous technique still has major disadvantages including those related to implantation without excision of the diseased native valve without direct view of the annulus, which increases the probability of developing perivalvular leaks and a high percentage of atrioventricular block. Due to the need for aggressive crimping of pericardial layers, there is uncertainty about their long-term durability. A new technique for AVR using sutureless bioprosthesis has recently been developed. The main advantages of this technique are the excellent haemodynamic performance and fast deployment under direct view, thereby avoiding the knotting of surgical stitches, which is especially advantageous in more technically demanding procedures (e.g. minimally invasive surgery, calcified aortic root and reoperations). The good clinical results of these valves have been supported by scientific evidence, making it a feasible option for patients who are candidates for AVR using biologic prosthesis, especially for those with mid-high surgical risk for standard AVR and percutaneous transcatheter valve implantation. In this article, we review the latest evidence on these new prostheses, including their advantages and possible disadvantages.
authors.affiliation: Department of Cardiac Surgery, Hospital de León, León, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Martínez-Comendador
authors.affiliation: Department of Cardiac Surgery, Hospital de León, León, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Castaño
authors.affiliation: Department of Cardiac Surgery, Hospital de León, León, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gualis
authors.affiliation: Department of Cardiac Surgery, Hospital de León, León, Spain.
authors.forename: Elio
authors.initials: E
authors.lastname: Martín
authors.affiliation: Department of Cardiac Surgery, Hospital de León, León, Spain.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Maiorano
authors.affiliation: Department of Cardiac Surgery, Hospital de León, León, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Otero
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011474:Prosthesis Design; D000071062:Sutureless Surgical Procedures / Q000379:methods*
keywords: Aortic stenosis ; Aortic valve replacement ; Minimally invasive surgery; Sutureless bioprosthesis 