Sutureless Valve Replacement Through a Right Anterior Mini-thoracotomy In Elderly Patients With Stenotic Bicuspid Aortic Valve.

OBJECTIVE: Several indications for sutureless aortic valve replacement (SU-AVR) have been a matter of debate. We evaluated our experience with Perceval-S® (LivaNova group, Saluggia, Italy) SU-AVR in patients with severe aortic stenosis (AS) involving bicuspid aortic valve (BAV), even though presence of BAV is still considered to be a contraindication for sutureless valves.

METHODS: From January 2013 through March 2018, thirteen patients with severe aortic stenosis involving BAV underwent SU-AVR with the Perceval-S® (LivaNova group, Saluggia, Italy) prosthesis in a single center. Preoperative evaluation included coronary catheterization and multi-sliced computerized tomography was performed in all patients. Three-dimensional transthoracic echocardiography was used to evaluate for obtaining the anatomy and phenotype of BAV. Minimally invasive approach through right anterior thoracotomy from third intercostal space was performed for all patients.

RESULTS: The mean age was 72.8 ± 2.26 years ranging from 70 to 77 and 53.8% (n=7) were male. The mean aortic valve gradient decreased from 46.4 ± 13.8 to 13.6 ± 4.4 mm Hg postoperatively. The mean aortic valve area increased from 0.69 ± 0.22, to 1.81 ± 0.38 cm2 . There was no in-hospital mortality. One patient (7.6%) had third-degree atrio-ventricular block requiring permanent pacemaker implantation. Mean follow-up was 15.1 ± 6.3 months (maximum 2 years).No major paravalvular leakage or valve migration occurred postoperatively.

CONCLUSION: This study shows that SU-AVR is a technically feasible and safe procedure in patients with severe AS and BAV with acceptable good surgical outcomes. Presence of BAV in AS should not be considered a contraindication to Perceval-S® prosthesis (LivaNova group, Saluggia, Italy).