Minimally Invasive Sutureless Aortic Valve Replacement With the Perceval S Bioprosthesis Through Ministernotomy: A Single-Center Experience

Objectives Minimally invasive aortic valve replacement has the potential advantage of faster postoperative recovery compared to open procedures. Moreover, aortic valve replacement with a sutureless valve shortens procedure time. The aim of this study is to report early postoperative outcomes and one-year survival of patients undergoing sutureless aortic valve replacement with the Perceval S bioprosthesis (LivaNova, Milan, Italy) through a ministernotomy. Methods A total of 110 patients underwent sutureless aortic valve replacement in our center with the Perceval S bioprosthesis through a ministernotomy between February 2016 and March 2019. Data regarding preoperative and operative details, hospital stay, postoperative outcomes within 30 days after surgery, and one-year mortality were assessed. Results The mean cross-clamping time and extracorporeal circulation time were 54 +/- 14 and 78 +/- 21 minutes, respectively. No conversion to full median sternotomy was needed perioperatively. In-hospital mortality was 0.9%. Postoperative peak gradient was 13.3 mmHg; no major paravalvular leakage or valve migration occurred postoperatively. Postoperative complications consisted of one (0.9%) patient requiring full sternotomy for bleeding and two (1.8%) patients requiring re-ministernotomy due to acute tamponade. Pacemaker implantation was needed in four (3.6%) patients. Postoperative ischemic stroke rate and newonset atrial fibrillation were 0.9% (n = 1) and 20% (n = 22), respectively, and one-year survival was 97.3%. Median intensive care unit and hospital stay were one and eight day(s), respectively. Conclusion Minimally invasive sutureless aortic valve replacement with the Perceval S bioprosthesis through a ministernotomy appears to be a safe procedure with good postoperative results and one-year survival. Further follow-up is needed to evaluate long-term outcomes.