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Various Uses of Sutureless Prostheses: a Single Center Experience
Giuseppe Santarpino, Ferdinand Vogt, Steffen Pfeiffer, Joachim Sirch, Francesco Pollari, Theodor Fischlein.
Klinikum Nürnberg, Nuremberg, Germany.

OBJECTIVE: Sutureless aortic bioprosthesis bear the potential of easy implantation, reduced ischemic time, and surgical trauma in aortic valve replacement. The aim of the study was to show clinical outcomes in our 4 years experience with patients undergoing sutureless aortic valve replacement with different indications.
METHODS: Between May 2010 and November 2013, 203 patients (age 78±5 years, female 108-53.2%) undergoing aortic valve replacement with the sutureless Perceval S bioprosthesis (Sorin Group, Saluggia, Italy) in isolated minimally invasive (111 patients), in REDO (20 patients: 8 with a degenerated aortic bioprosthesis, 12 underwent CABG) or in combined procedures (72 patients: 49 CABG, 1 mitral valve replacement, 3 CABG+LAA-closure, 1 1/3 Yacoub, 1 TEA Carotid, 3 Tricuspid valve reconstruction, 1 myomectomie+CABG, 1 aortic ascending replacement+CABG, 1 VSD-Closure, 6 LAA-Closure, 4 Minimaze+LAA closure, 1 myectomie). In-hospital and follow up clinical and echocardiographic data were collected for all patients.
RESULTS: The patients received a size S (13), M (77),L (97) or XL (16) prosthesis. In the minimally invasive group, 103 patients received a "J" sternotomy and 8 a right thoracotomy. Mean logistic European system for cardiac operative risk evaluation was 13±11.6%, mean aortic cross-clamp time was 44±17.5 minutes (38±12.7 minutes for isolated minimally invasive procedures). In-hospital mortality was 2.5 %. We recorded 15 pacemaker implantations (7.4%). At follow-up (months 20±11), we observed 6 deaths (2 cardiac). Mean transprosthetic gradients were 13,3±5, 13,1±4.6, 13.6±5, 13.2±3.8 mmHg at 6 months, 1 year, 2 years and 3 years respectively.
CONCLUSIONS: Implantation of the sutureless Perceval S valve is associated with short cross-clamp time, reducing surgical trauma, and resulting in improved clinical outcome. This self-anchoring valve is a useful tool in many different indications, expecially in an elderly and high risk population.

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