Efficacy of sutureless aortic valves in minimally invasive cardiac surgery: an evolution of the srugical techniques.

BACKGROUND: Sutureless aortic valve prostheses have the potential of shortening surgical time, but if this results in improved clinical outcome remains to be determined. The aim of this study was to compare the outcome of patients undergoing conventional vs minimally invasive AVR, with either a stented or sutureless bioprosthesis.

METHODS: From 2007 to 2015, 627 patients underwent elective isolated AVR and were divided into three groups: 206 patients who underwent sutureless-AVR via J- sternotomy (A) and patients who underwent stented-AVR via J- sternotomy (B, n=247) or full-sternotomy (C, n=174).

RESULTS: A-patients were significantly older than B and C (77±5 vs 74±7 and 70±8years, p<0.001). Aortic cross-clamp and cardiopulmonary bypass times were shorter in A than in B and C. As expected, aortic cross-clamp time was prolonged in B as compared to A and C (60±18 vs 36±10 and 54±16min, p<0.001). After Multivariate adjustment minimally invasive AVR resulted in significantly fewer postoperative complications in terms of drainage bleeding and the need for blood transfusions (385±287 vs 500±338mL, p=0.006 and 1.3±2.1 vs 1.8±2.6IU, respectively; p=0.001). No differences in postoperative outcomes were observed among groups.

CONCLUSIONS: The minimally invasive approach confers a protective effect against bleeding complications, but it is time consuming. The use of sutureless valves is associated with significantly shorter surgical times compared with stented bioprostheses. In addition, no differences in mortality were observed among groups, and patients who received a sutureless valve, though significantly older, showed a better clinical outcome than patients who received a stented valve.