Sutureless Aortic Valve Replacement: A Canadian Multicentre Study

Background: Sutureless aortic valve replacement (AVR) has recently been introduced as an alternative to standard AVR in elderly high-risk surgical patients. The purpose of this study was to report the early Canadian experience with sutureless AVR. Methods: A Canadian multicenter study included 215 consecutive patients from 6 centres who underwent sutureless AVR using the Perceval S bioprosthesis (Sorin Group, Saluggia, Italy) between June 2011 and May 2013. Perioperative clinical and echocardiographic outcomes were assessed in all patients. Results: Mean age was 79 +/- 6 years, and 116 patients (54%) were women. Concomitant procedures included coronary artery bypass grafting in 86 patients (40%), multiple valve procedures in 24 (11%) patients, and septal myectomy in 9 (4%) patients. A full sternotomy was used in 173 cases (80%), a minithoracotomy in 23 (11%) cases, and a partial sternotomy in 19 (9%) cases. Nineteen cases (9%) were redo procedures. For isolated AVR, mean aortic cross-clamp time was 41 +/- 12 minutes. In-hospital mortality occurred in 9 patients (4%). No postoperative valve migration was reported. A total of 37 patients (17%) underwent postoperative implantation of a permanent pacemaker, including 20 patients (9%) who had complete atrioventricular block. Postoperative stroke occurred in 7 patients (3%). Echocardiographic evaluation demonstrated well-seated valves with no significant (2+) valvular or paravalvular aortic insufficiency and a mean aortic gradient of 13 +/- 6 mm Hg. Conclusions: Sutureless AVR using the Perceval S prosthesis is safe and reproducible and results in short operative times. Echocardiographic results are encouraging, with low gradients and no paravalvular aortic insufficiency. However, in this series, sutureless AVR was associated with a high risk of permanent pacemaker implantation.