Sutureless Aortic Valve Replacement via partial Sternotomy
JWGoethe University of Frankfurt, Frankfurt, Germany.
OBJECTIVE:
For elderly patients with symptomatic aortic valve stenosis, aortic valve replacement (AVR) with tissue valves is still the treatment of choice. Stentless valves were introduced to clinical practice for better hemodynamic features as compared to stented tissue valves. However, the implantation is more complex and time demanding, especially in minimal invasive AVR. We present our clinical data on 22 patients having received a sutureless ATS 3f EnableTM Aortic Bioprosthesis via partial upper sternotomy.
METHODS:
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, mean logistic Euroscore was 13. Subvalvular myectomy was performed in two patients. Prosthetic valve sizes were 19mm (n=1), 21mm (n=7), 23mm (n=6), 25mm (n=6) and 27mm (n=2).
RESULTS:
Implantation of the valve required 10±6min. Cardiopulmonary bypass and aortic crossclamp time were 87±16 and 55±11min, respectively. Early mortality (<90 days) was 9% (2 patients). No paravalvular leakage was detected intraoperatively or in follow up echocardiography. The mean transvalvular gradients were 9±6mmHg at discharge and 9±2mmHg at one year follow up.
CONCLUSIONS:
Sutureless valve implantation via partial sternotomy is feasible and safe with the ATS 3f EnableTM bioprosthesis. Reduction of CPB and aortic crossclamp time appears 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.
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