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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Aortic valve replacement with sutureless prosthesis: better than root enlargement to avoid patient-prosthesis
Erik Beckmann1, Andreas Martens1, Firas Alhadi1
1Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Interactive Cardiovascular and Thoracic Surgery
|February 28, 2016
Summary
Sutureless aortic valve replacement offers a faster procedure than aortic root enlargement (ARE) for small aortic annuli, with comparable survival rates. This approach is particularly beneficial for older patients, reducing cardiac ischemia time and avoiding patient-prosthesis mismatch (PPM).
Area of Science:
- Cardiovascular Surgery
- Biomaterials in Medicine
- Prosthetic Devices
Background:
- Aortic valve replacement in patients with small aortic annuli can lead to patient-prosthesis mismatch (PPM).
- Aortic root enlargement (ARE) is a procedure to mitigate PPM but increases cardiac ischemia duration.
- Sutureless valves present a potential solution to prevent PPM while reducing operative times.
Purpose of the Study:
- To compare the outcomes of sutureless valve implantation versus conventional aortic root enlargement (ARE) in patients with small aortic annuli.
- To evaluate the efficacy of sutureless valves in preventing patient-prosthesis mismatch (PPM).
- To assess the impact of both procedures on cardiac ischemia times and patient survival.
Main Methods:
- A retrospective comparative study of 128 patients with small aortic annuli undergoing aortic valve replacement between 2007 and 2011.
- Thirty-six patients received conventional valve replacement with ARE, while 92 received sutureless valve implantation (Sorin Perceval).
- Follow-up data was collected to compare operative times, effective orifice area (EOA), PPM rates, and survival.
Main Results:
- Sutureless valve patients were older and had more concomitant procedures but experienced significantly shorter operation, bypass, and cross-clamp times.
- Mean indexed EOA was slightly lower in the sutureless group (0.83 cm²/m²) compared to ARE (0.91 cm²/m²), with no significant difference in severe PPM rates.
- 30-day mortality was comparable, and 1- and 5-year survival rates favored the sutureless group, though not significantly.
Conclusions:
- Sutureless valve implantation is a viable alternative to ARE for small aortic annuli, effectively reducing cardiac ischemia times.
- Despite a slightly lower indexed EOA, sutureless valves do not significantly increase PPM and offer comparable survival rates.
- This technique is especially advantageous for geriatric patients due to the expedited implantation process.
Keywords:
Aortic root enlargementAortic valve replacementPatient–prosthesis mismatchSorin PercevalSutureless valves
