Surgical Treatment of Severe Aortic Stenosis: Sutureless Versus Stented Bioprosthetic Aortic Valve Replacement

Objective: The aim of this study is to analyze the effects of sutureless aortic valve bioprosthesis implantation compared with stented conventional bioprosthesis in patients with severe aortic stenosis. This is a propensity matching institutional study. Materials and Methods: We compared 37 patients who underwent aortic valve replacement with Carpentier Edwards Perimount implantation (group 1) with 37 patients with sutureless Perceval S implanted (group 2). Preoperative, intraoperative, and postoperative parameters were studied. Results: The cross-clamp time, the mechanical ventilation times, the intensive care unit, and the hospital stay were significantly shorter in group 2 than in group 1 (p-value < 0.001). The cardio-pulmonary bypass time was 74 [45, 201] minutes in group 2 and 82 [48, 654] minutes in group 1 (p-value = 0.113). The postoperative mean gradients were 13 [6, 44] mmHg in group 2 and 14 [6, 19] mmHg in group 1 (p-value 0.285), and the effective orifice areas in these two groups were 1.5 ± 0.18 cm² vs. 1.1 ± 0.4 cm² (p = 0.002). The percentage of minimally invasive approach was higher in group 2 than in group 1. The echocardiographic follow-up analysis showed that the mean and maximum gradients with a sutureless prosthesis implant were lower than that of a traditional prosthesis, although this difference was not statistically significant. Conclusions: The Perceval S valve seems to be an effective alternative solution for biological valve implantation with good hemodynamic characteristics as compared with Carpentier Edwards Perimount prosthesis, providing shorter ischemic and extracorporeal circulation time and better postoperative recovery. Perceval S valve implantation facilitates the minimally invasive approach.