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Objective: Bicuspid aortic valve (BAV) is generally considered to be a contraindication to sutureless aortic valve replacement (AVR). The aim of this study was to evaluate the feasibility and perioperative outcomes of this technique in patients with BAV.Methods: From June 2011 to January 2014, a total of 25 patients who underwent sutureless AVR had documented BAV. Thirteen patients (52%) had median sternotomy, and 12 patients (48%) a minimally invasive approach. Results:The study population included 17 (68%) men with a median age of 77.8 AE 5.4 years. The mean EuroSCORE II was 3.4% AE 2.6%. Concomitant procedures included coronary artery bypass grafting in 8 patients (32%), 2 AVRs (8%), 1 mitral valve repair (4%), 1 septal myomectomy (4%), and 1 atrial septal defect closure (4%). The mean transaortic valve gradient decreased from 49.4 AE 15.7, to 14.5 AE 5.4 mm Hg postoperatively. The mean aortic valve area increased from 0.78 AE 0.18, to 1.75 AE 0.43 cm 2 postoperatively. Five patients (20%) suffered from atrioventricular block that required permanent pacemaker implantation. Two patients (8%) suffered a stroke. No major paravalvular leakage occurred, and no postoperative valve migration. In-hospital mortality occurred in 1 patient (4%). The mean intensive care unit length of stay was 3 AE 2 days postoperatively.Conclusions: This study demonstrates that a sutureless aortic valve can be deployed in patients with BAV without increasing the risk of paravalvular leakage. BAV should not be considered a contraindication to sutureless AVR.

Use of an extra-aortic annuloplasty ring is effective at reducing annular diameters. This remains stable at mid-term follow-up, with preservation of aortic annular dynamics. Longer-term studies are required to determine the continued stability and impact on long-term clinical outcomes.

heart-failure-related adverse events and re-admissionsin patients undergoing mitral valve replacement (MVR) compared tomitral valve repair for severe ischemic MR. However, the relative merits of type of prosthesis (mechanical vs. biological) are unknown. The objective of this study was to assess the clinical outcomes after MVR among patients with biologic or mechanical prostheses in this setting. METHODS: Between 2000 and 2014, 302 patients underwent MVR for severe ischemic MR. Mechanical prosthetic valves were implanted in 199 patients (group M), and bioprostheses in 103 patients (group B). Provincial vital statistics and administrative hospital re-admission data were used to evaluate outcomes. Age-adjusted long-term survival and freedom from hospital re-admission events were assessed with Kaplan-Meier plots and Cox proportional hazards modeling was used. Follow-up was up to a maximum of 14.9 years. RESULTS: Baseline characteristics were comparable between the two groups, except for age at operation (group M: mean 64.9 AE 9.3 years vs. group B: mean 73.2 AE 6.3 years, p < 0.0001). Median EuroSCORE II was 9.2 AE9.7 for group B vs. 10.9 AE 11.1 for group M (p¼0.16). In-hospital mortality (11.6% vs. 12.6%, p¼0.85), and early post-operative adverse events were not significantly different between both groups. The risk of late re-operation on the mitral valve (1.7% vs. 2.2%, p¼0.99) was comparable between groups M and B, respectively. However, patients in group M were more frequently re-admitted to hospital for CVA/TIA (11.4% vs. 2.2%, p¼0.009), and serious bleeding (17.6% vs. 2.2%, p¼0.0001) during follow-up. Age-adjusted late survival was 67.4% and 37.2% (group M) vs. 67% and 36.6% (group B) at 5 and 10 years (log rank p¼0.95). In the Cox proportional hazards model, type of prosthesis did not independently influence late death (adjusted HR 1.18, 95% CI 0.70 e 1.99, p ¼ 0.54). However, mechanical prosthesis was associated with an increased risk of re-admission for late cardiovascular events (adjusted HR 1.58, 95% CI 1.1.05 e 2.38, p ¼ 0.03). CONCLUSION: Our data suggest that there is no long-term benefit of implanting a mechanical prosthesis at the time of MVR for severe ischemic MR in terms of survival, valve durability and the avoidance of re-operation. In addition, there may be an increased risk of neurologic events and serious bleeding associated with mechanical prostheses for this indication.

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