History, development and clinical perspectives of sutureless and rapid deployment surgical aortic valve replacement

Abstract

Degenerative aortic stenosis is the most frequent valvular heart disease in industrialized countries. Conservative treatment may beneficially influence symptoms but is never successful. Surgical aortic valve replacement (SAVR) was the only recognized treatment option to provide substantially prolonged survival until 2008. Operative mortality of isolated SAVR has been reported as low as 0.5% to 1% in experienced institutions, while long-term survival is close to that observed in a control healthy population of similar age. A multitude of studies have demonstrated the beneficial effects of SAVR with regard to improvement in quality of life and physical performance in the majority of symptomatic patients. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as an equal treatment modality, first in patients with high surgical risk and more recently in patients with intermediate and low surgical risk. Paravalvular regurgitation and the higher rate of pacemaker implantation remain points of consideration. Additionally, the long-term durability of TAVI devices and occurrence of stroke late after TAVI require additional analyses. Sutureless (SU-SAVR) and rapid deployment valve (R-SAVR) were designed to simplify and accelerate a conventional or less invasive surgical procedure while allowing complete excision of the calcified native valve. From 3 different implants tested more than 10 to 15 years ago, only two are available on the market today: the Perceval ® valve from Liva Nova and the Intuity ® sutureless prosthesis from Edwards Lifesciences. There has been extensive experience with these two devices in previous years and the results obtained are comparable to those observed following the use of conventional implants. The sutureless devices may be of particular interest for more complex and combined surgical procedures. This review summarizes the sutureless (SU-SAVR) and rapid deployment valve technologies and presents a clinical outlook for the patient population managed with these devices.

Single-center experience in sutureless aortic valve implantation using two aortic valve prostheses

“…Regarding postoperative ECG alterations, we saw a statistically relevant higher amount of alterations in general in Group B. LBBB was observed in both groups but more frequent in Group B (13 patients vs. ive patients), as well as atrial ibrillation and atrioventricular blockage (AV-block). The nitinol stent of the Sorin Perceval S and the expandable skirt of the Edwards Intuity may lead to higher tension in the left ventricular out low tract (LVOT) which results in tension in the atrioventricular conduction tissue [19]. Two patients in Group A and four in Group B needed a permanent transvenous pacemaker within the same hospital stay.…”

“…After Edwards Intuity implantation, pacemaker rates vary up to 12%, so our 9.2% rate in Group B is within this range (6;15). Higher pacemaker rates can be explained by comparing the mechanism of sutureless aortic valves to TAVI [19], although further comparisons to conventional bioprostheses are needed [17].…”

Updates on the Latest Surgical Approach of the Aortic Stenosis

“…The preliminary results are waited for 2023. Sutureless prostheses may be of particular interest for complex and combined procedures and to a lesser degree for small aortic annulus and heavily calcified aortic roots [29].…”

Sutureless bioprosthesis for aortic valve replacement: surgical and clinical outcomes

“…Aortic valve stenosis is the most frequent type of adult valvular heart disease in industrialized countries (1). Its prevalence increases with age with up to 9.8% in the 80-89 year cohort (2) (3).…”

“…1 Impaired renal function was defined as glomerular filtration rate <85%2 Overweight/obesity was defined as a body mass index >25.3 Former or active.Isolated AVR was performed in 122 (62.24%) patients. Concomitant single CABG surgery was performed in 22 (11.22%) patients, double CABG surgery in 23 (11.73%) and triple CABG surgery in 4 (2.04%).…”