Conventional Biological versus Sutureless Aortic Valve Prostheses in Combined Aortic and Mitral Valve Replacement

Abstract

Background: Sutureless aortic valve prostheses have proven to provide a significant decrease in procedural, cardiopulmonary bypass and cross-clamp time, leading to a significant reduction in mortality risk in elderly high-risk cohorts. In this study, we sought to review our institutional experience on the sutureless aortic valve replacement (SU-AVR) and the concomitant mitral valve replacement (SMVR), comparing the combined conventional surgical aortic valve replacement (SAVR) with SMVR. Methods and Material: Between March 2018 and July 2022, 114 consecutive patients underwent a combined aortic and mitral valve replacement at our institution. We stratified the patients according to the operative procedures into two groups and matched them 1:2: Group 1 underwent a combined conventional SAVR and SMVR (n = 46), and Group 2 included combined SU-AVR with Perceval prosthesis and SMVR (n = 23). Results: No significant differences in the preoperative characteristics were present. SU-AVR combined with SMVR demonstrated excellent haemodynamic performance, comparable to that of SAVR plus SMVR, with median postoperative gradients over the aortic valve of 4 mmHg (IQR 3.0–4.0) in Group 1 and 4 mmHg (IQR 3.0–4.0) in Group 2 (p = 0.67). There was no significant difference in the occurrence of postoperative major adverse events such as death, stroke, myocardial infarction and kidney failure between the groups. There was also no significant difference in the permanent pacemaker implantation rate, paravalvular leakage or valve dislocation. We also could not detect any significant difference in postoperative mortality between the groups. Conclusions: SU-AVR has proven to be a reliable alternative to conventional valve prostheses in patients with multivalve disease undergoing combined aortic and mitral valve replacement, offering shorter procedural time and outstanding hemodynamic performance compared to the conventional surgical method.

Sutureless Aortic Valve Prosthesis in Redo Procedures: Single-Center Experience

“…These results are encouraging when taking into consideration the previously reported rates of permanent pacemaker implantation following SU-AVR [ 26 ]. It is of importance to re-emphasize the significance of avoiding oversizing to reduce the mechanical stress on the atrioventricular node [ 18 ].…”

“…Sutureless aortic valves have been found to decrease the overall operative time, cardiopulmonary bypass (CPB) time, and aortic cross-clamp (CC) time [ 17 ] while facilitating minimally invasive approaches such as non- or partial sternotomy minimally invasive AVR [ 18 ]. By eliminating the sewing ring at the valve’s base, the effective orifice area is maximized, resulting in a significant improvement in postoperative gradients [ 19 , 20 ].…”

Single-Center Real-World Experience with Sutureless Aortic Valve Prosthesis in Isolated and Combined Procedures

“…Our research, however, centers on a cohort treated by a team that has mastered the ‘Snugger Method’ of implantation, yielding consistently favorable outcomes since its establishment in 2017. Moreover, our study explores Perceval prosthesis application across a range of indications, including those considered off-label in Europe, such as infective endocarditis, multivalve disease and isolated aortic regurgitation, all of which we have already described in our previous research suggesting Perceval’s feasibility in all the alternative indications [ 11 , 25 , 27 , 28 ]. Our real-world cohort, informed by the practical wisdom of centers globally, presents a unique opportunity to learn from their experiences and avoid early missteps like oversizing.…”

The 7 Pillars for Perceval Implantation With Mitral Valve Repair or Replacement

“…Several studies have examined this topic. 4,[6][7][8][9] The most recent and largest paper examined 114 patients undergoing combined aortic valve replacement (AVR) and mitral operations with either Perceval or a sutured aortic bioprosthesis. The average age in both groups was over 70 years, and the average EuroSCORE was about 6.…”

“…The operative times were shorter in the Perceval group, but there were no differences in mortality or morbidity in this high-risk group of patients. 8 As the experience and knowledge grows in this area, there will be opportunity for improvement in outcomes, and further studies will be needed. In combined AVR with Perceval and mitral operations, there are some considerations to help ensure success.…”