Sutureless valves and the quality of perfusion: towards a goal directed aortic valve replacement

Aim of this study was to assess the potential differences in respecting the principles of goal-directed perfusion between aortic valve replacement with sutureless vs. conventional stented bioprostheses.

Data from 94 consecutive patients undergoing aortic valve replacement with Perceval sutureless valve, with or without concomitant coronary artery bypass grafting, were compared to a contemporary cohort of 116 patients receiving conventional stented bioprostheses. Propensity score matching was used to reduce selection bias. Flow-dependent estimate of oxygen delivery and carbon dioxide production were compared in accordance to the principles of goal directed perfusion. Hospital outcomes were assessed as well.

Propensity score matching resulted in 39 pairs with similar characteristics and operative risk. Cross-clamping time (41.6±20.6 vs. 89.6±48.2; P<0.001) and cardiopulmonary bypass time (66.9±29.4 vs. 121.2±56.6, P<0.001) were shorter in Perceval patients. Flow-dependent parameters were significantly better in Perceval patients (peak VCO2i P=0.010; nadir VO2i P=0.035; nadir DO2i/VCO2i P=0.015; peak RQ P=0.020) and therefore goal-directed perfusion principles were met more frequently (all P<0.001). Peak lactates were higher in controls (P=0.001), as well as number of patients receiving transfusions during CPB (P=0.044). QualyP Score was also higher in controls (P<0.001). Perceval patients experienced reduced postoperative bleeding, had a lower incidence of surgical revisions and transfusions. Duration of ventilation was longer in controls.

The use of sutureless valves significantly reduces cardiopulmonary bypass and cross-clamping times and contributes to achieve a goal-directed perfusion. This results in better perfusion quality, with a positive clinical impact.