Sutureless Aortic Valve Replacement via Partial Sternotomy

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> For elderly patients with symptomatic aortic valve stenosis, aortic valve replacement with tissue valves is still the treatment of choice. Stentless valves were introduced to clinical practice for better hemodynamic features as compared with stented tissue valves. However, the implantation is more complex and time demanding, especially in minimal invasive aortic valve replacement. We present our clinical data on 22 patients having received a sutureless ATS 3f Enable aortic bioprosthesis via partial upper sternotomy. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> The procedure was performed using CPB with cardioplegic arrest. After resection of the stenotic aortic valve and debridement of the annulus, the valve was inserted and released. Mean age was 79 years, and mean logistic Euroscore was 13. Subvalvular myectomy was performed in two patients. Prosthetic valve sizes were 19 mm (n = 1), 21 mm (n = 7), 23 mm (n = 6), 25 mm (n = 6), and 27 mm (n = 2). </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Implantation of the valve required 10 ± 6 minutes. Cardiopulmonary bypass and aortic crossclamp time were 87 ± 16 and 55 ± 11 minutes, respectively. Early mortality (&lt;90 days) was 9% (2 patients). No paravalvular leakage was detected intraoperatively or in follow-up echocardiography. The mean transvalvular gradients were 9 ± 6 mm Hg at discharge and 8 ± 2 mm Hg at 1-year follow-up. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Sutureless valve implantation via partial sternotomy is feasible and safe with the ATS 3f Enable bioprosthesis. Reduction of cardiopulmonary bypass and aortic crossclamp time seems possible with increasing experience. Hemodynamic data are very promising with low gradients at discharge and after 12 month. Sutureless valve implantation via minimal invasive access may be an alternative treatment option for elderly patients with high comorbidity. </jats:p></jats:sec>

Sutureless Prostheses and Less Invasive Aortic Valve Replacement: Just an Issue of Clamping Time?

“…Sutureless aortic bioprostheses seem to provide shorter implantation time in full sternotomy settings [12]. The real advantage of such devices is to facilitate and expedite AVR in conditions of difficult placement of surgical stitches, such as severely calcified aortic roots [13,14] and minimally invasive approaches [11,15,16]. In this study, we aimed to show the results of the transition from conventional bioprostheses to the 3f Enable sutureless bioprosthesis for the MS approach, within an institutional program of routine adoption of MIAVR.…”

“…Implantation has also been reported to be feasible through MS [11], as well as right MT [5]. We present herein the impact of the transition from conventional aortic bioprostheses to the routine use of a sutureless valve in the MS aortic valve replacement (AVR) experience of a mid-sized French cardiac surgical center.…”

Clinical experience with the ATS 3f Enable® Sutureless Bioprosthesis☆☆☆

“…To evaluate the safety and clinical performance of the bioprosthesis, a prospective, multicenter clinical trial was initiated. Single-center experiences were published in 2009 and 2010 [10][11][12]; the minimally invasive approach using partial sternotomy was first reported in 2010 [13]. It is the objective of this report to present the intermediate data of this prospective, multicenter clinical study enrolling patients at 10 European investigational sites.…”

The 3f Enable sutureless bioprosthesis: Early results, safeguards, and pitfalls

“…As for surgical technique, the 3f Enable bioprosthesis can be implanted via a ministernotomy or minithoracotomy, 18,19 but minimally invasive surgery must be carried out only by groups experienced in such techniques, gradually reducing the size of the incision and always beginning the learning curve with a full median sternotomy. All of our cases have been performed by full median sternotomy for 2 reasons: to exceed our own learning curve and because we are a referral center for learning about the 3f Enable prosthesis (25% of the cases have been performed with visiting surgeons from other centers).…”