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J Chest Surg

Published online March 26, 2024

Copyright © Journal of Chest Surgery.

Clinical Midterm Results of Surgical Aortic Valve Replacement with Sutureless Valves

Soonchang Hong , M.D.1, Jung-Woo Son , M.D.2, Yungjin Yoon , M.D.1

Departments of 1Cardiothoracic Surgery, and 2Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to:Soonchang Hong
Tel 82-33-741-0588
Fax 82-33-742-0666
E-mail hongsc93@yonsei.ac.kr
ORCID
https://orcid.org/0000-0001-6415-8243

Received: October 10, 2023; Revised: December 20, 2023; Accepted: January 18, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Sutureless aortic valves may enable shorter procedure times, which benefits patients with elevated surgical risk. We describe the outcomes of patients with aortic stenosis who underwent aortic valve replacement (AVR) using the sutureless Perceval aortic bioprosthesis.
Methods: Data from a retrospective cohort were obtained from a clinical database. The study enrolled patients with symptomatic severe aortic stenosis who underwent surgical AVR with a sutureless bioprosthesis between August 2015 and December 2020. In total, 113 patients were included (mean age, 75.3±8.4 years; 57.5% women; median Society of Thoracic Surgeons score, 9.7%; mean follow-up period, 51.19±20.6 months). Of these patients, 41 were octogenarians (36.2%) and 3 were nonagenarians (2.6%). Transthoracic echocardiography was employed to assess changes in ejection fraction (EF), left ventricular mass index (LVMI), and mean pressure gradient (MPG).
Results: The in-hospital mortality rate was 2.6%, and 13 patients developed new-onset atrial fibrillation. A permanent pacemaker was implanted in 3 patients (2.6%). The median intensive care unit stay was 1 day (interquartile range [IQR], 1–2 days), and the median hospital stay was 12 days (IQR, 9.5–15 days). The overall survival rate at 5 years was 95.9%. LVMI and MPG were reduced postoperatively, while EF increased over the follow-up period. No structural valve deterioration was observed, and no meaningful paravalvular leakage developed during follow-up.
Conclusion: The use of a sutureless valve in the aortic position is safe and feasible, even for high-risk elderly patients requiring surgical AVR. LVMI and MPG decreased postoperatively, while EF increased over the follow-up period.

Keywords: Aortic stenosis, Aortic valve replacement, Thoracic surgery, Adult, Heart valve disease

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J Chest Surg

Published online March 26, 2024

Copyright © Journal of Chest Surgery.

Clinical Midterm Results of Surgical Aortic Valve Replacement with Sutureless Valves

Soonchang Hong , M.D.1, Jung-Woo Son , M.D.2, Yungjin Yoon , M.D.1

Departments of 1Cardiothoracic Surgery, and 2Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to:Soonchang Hong
Tel 82-33-741-0588
Fax 82-33-742-0666
E-mail hongsc93@yonsei.ac.kr
ORCID
https://orcid.org/0000-0001-6415-8243

Received: October 10, 2023; Revised: December 20, 2023; Accepted: January 18, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Sutureless aortic valves may enable shorter procedure times, which benefits patients with elevated surgical risk. We describe the outcomes of patients with aortic stenosis who underwent aortic valve replacement (AVR) using the sutureless Perceval aortic bioprosthesis.
Methods: Data from a retrospective cohort were obtained from a clinical database. The study enrolled patients with symptomatic severe aortic stenosis who underwent surgical AVR with a sutureless bioprosthesis between August 2015 and December 2020. In total, 113 patients were included (mean age, 75.3±8.4 years; 57.5% women; median Society of Thoracic Surgeons score, 9.7%; mean follow-up period, 51.19±20.6 months). Of these patients, 41 were octogenarians (36.2%) and 3 were nonagenarians (2.6%). Transthoracic echocardiography was employed to assess changes in ejection fraction (EF), left ventricular mass index (LVMI), and mean pressure gradient (MPG).
Results: The in-hospital mortality rate was 2.6%, and 13 patients developed new-onset atrial fibrillation. A permanent pacemaker was implanted in 3 patients (2.6%). The median intensive care unit stay was 1 day (interquartile range [IQR], 1–2 days), and the median hospital stay was 12 days (IQR, 9.5–15 days). The overall survival rate at 5 years was 95.9%. LVMI and MPG were reduced postoperatively, while EF increased over the follow-up period. No structural valve deterioration was observed, and no meaningful paravalvular leakage developed during follow-up.
Conclusion: The use of a sutureless valve in the aortic position is safe and feasible, even for high-risk elderly patients requiring surgical AVR. LVMI and MPG decreased postoperatively, while EF increased over the follow-up period.

Keywords: Aortic stenosis, Aortic valve replacement, Thoracic surgery, Adult, Heart valve disease

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