10-Year Survival and Hemodynamic Outcomes following Sutureless Aortic Valve Replacement: A Preliminary Single-Center Analysis

Objectives: Surgical aortic valve replacement with a sutureless prosthesis (Su-AVR) was introduced in last decade as an attractive alternative to conventional AVR especially in elderly and high-risk patients or in candidates for a minimal invasive approach. However, data regarding long-term outcomes and prosthesis durability are still lacking.

Methods: We retrospectively analyzed 602 patients who underwent successfully AVR with a sutureless prosthesis in our center between 2010 and 2020. Indication for Su-AVR was severe aortic valve stenosis or degenerated aortic valve prosthesis in high- or intermediate risk patients. All isolated Su-AVR were performed through a mini-J sternotomy. A follow-up including a transthoracic echocardiography was performed in our institutional outpatient's ward up to August 2020.

Result: Mean age was 76.5 ± 5.2 years, 52% were female, 4% were in dialysis, 8.3% had a prior cardiac surgery, mean logistic EuroSCORE was 14% ± 12, mean EuroSCORE II 3.7% ± 4. Fifty-four patients received a size “S,” 210 received an “M,” 234 received an “L” and 104 patients an “XL.” 35% underwent a combined procedure such as a concomitant CABG (n = 145) or an intervention on the mitral valve (n = 14). Overall 30-day mortality was 3.3%, and 2% for isolated Su-AVR.

Following mean gradients were observed: 12 ± 4.4 mm Hg at 1st year; 12.9 ± 5.1 at 2nd year; 12.1 ± 6 mm Hg at 3rd year; 12 ± 5.6 mm Hg at 4th year; 16.8 ± 15 at 5th year; 13.6 ± 13 at 10th year.

Incidence of paravalvular leaks (PVL) > mild was 0% at 1 year and remained stable; 2.9% (2 over 68 patients) showed a moderate PVL after 10 years. Reintervention rate, Re-AVR, or TAVI, due to structural deterioration was: 0.17% after 1 year, 1% after 3 years, 5.7% after 5 years, 5.8% after 10 years.

Seven patients experienced a prosthetic valve endocarditis (PVE) at follow-up (1.2%). Of these, four patients had an early PVE (2, 4, 5, and 10 months after implantation), and 3 patients a late PVE (1 case after 3 years and 2 cases after 5 years).

Conclusion: Clinical outcomes and hemodynamic performance of sutureless AVR were excellent. Incidence of prosthesis degeneration and endocarditis were low in this long-term follow-up.

Publication History

Article published online:
19 February 2021