Sutureless aortic valve replacement with the Trilogy Aortic Valve System: Multicenter experience

Objective: To evaluate the modular sutureless Arbor Trilogy Aortic Valve System (Arbor Surgical Technologies, Irvine, Calif), designed for minimally invasive aortic valve replacement. Methods: In a prospective multicenter study, 32 patients with severe aortic valve stenosis underwent aortic valve replacement with the Trilogy valve between 2006 and 2008. Concomitant coronary artery bypass grafting was performed in 6 patients. Transthoracic echocardiography was performed at baseline, at discharge, at 4 to 6 months, at 11 to 14 months, and annually thereafter. Results: Valve implantation was successful in 30 patients. The procedure was converted to conventional aortic valve replacement in 2 patients. Mean bypass time was 111 +/- 42 minutes, and crossclamp time was 70 +/- 23 minutes. Valve implantation took 21 +/- 7 minutes. The transvalvular gradients at discharge were 10 +/- 3 mm Hg (mean) and 20 +/- 7 mm Hg (peak), and the effective orifice area was 1.9 +/- 0.4 cm(2). At 2-year follow-up, gradients were 7 +/- 3 mm Hg (mean) and 14 +/- 4 mm Hg (peak), and the effective orifice area was 1.9 +/- 0.3 cm(2). There was no intraoperative mortality: Two patients died of causes unrelated to the valve during follow-up. One redo aortic valve replacement was performed at 22 months for prosthetic valve endocarditis. Conclusions: Sutureless aortic valve replacement is feasible and safe with the Trilogy System. After an initial learning curve, the modular valve design allows a more rapid and simple implantation compared with conventional stented tissue valves. The simplicity may also facilitate a greater adoption of minimally invasive aortic valve replacement by a broader spectrum of surgeons. (J Thorac Cardiovasc Surg 2010;140:878-84)