Journal Article

Prognostic impact of small size sutureless prostheses: results for 241 patients from an international registry

Bisleri, Gianluigi, Cosco, Valeria, Ramlawi, Basel, Dinges, Christian, Lorusso, Roberto, Castillo, Josè Cuenca, Pacini, Davide, Minniti, Giuseppe, Nobre, Angelo Lucas, Royse, Alistair, Corbi, Pierre, Salvador, Loris, Glauber, Mattia, Baghai, Max, Grimaud, Jean-Philippe, Torella, Michele, Parrino, Patrick, Fontaine, Raphael, D’Anna, Veronica, Scherner, Maximilian, Concistrè, Giovanni, Heimansohn, David, Troise, Giovanni, Rinaldi, Mauro, Pappalardo, Aniello, Connolly, Mark, Hughes, George Chad, Fischlein, Theodor, D’Agnano, Jlenia, Argano, Vincenzo, Zakova, Daniela, Vigano, Giorgio, Walker, Antony, Mastrogiovanni, Generoso, Santarpino, Giuseppe, Noirhomme, Philippe, Muñoz, Ignacio, Maroto, Luis, Solinas, Marco, Asimakopoulos, George

2025

Overview

Background The treatment of aortic valve disease in small annuli remains a debated topic in terms of prosthetic choice - biological or mechanical - and risk of patient prosthesis mismatch. Methods The clinical data of the 241 patients who received a small size sutureless prosthesis from the Sorin Universal REgistry on Aortic Valve Replacement (SURE-AVR) (NCT02679404) were analysed at 30 days and at follow-up. The mean age was 75.5 ± 7.8 years (89.2% female); the mean Society of Thoracic Surgeons (STS) score was 4.2 ± 3.2%, and the preoperative NYHA class II or III score was 83.8%. A minimally invasive approach was performed in 52.7% of patients; concomitant procedures were performed in 27.8% of patients. Similar aortic clamping and cardiopulmonary bypass times were observed in the overall isolated cohort and the isolated minimally invasive cohort. The mean intensive care unit (ICU) stay was 2.4 ± 2.0 days and the total length of stay was 10.3 ± 6.1 days. Results Three deaths were recorded at 30 days (1.2%), 2 for noncardiac causes. One patient experienced a myocardial infarction (0.4%) and 2 a nondisabling stroke (0.8%). 2 patients showed intraprosthetic leakage ≥ 2 and one patient para-prosthetic leakage ≥ 2; of these, one patient required reoperation with prosthesis removal. 4.1% of patients required a pacemaker implant. At a maximum follow-up of 8.1 years, 10 cardiovascular deaths, 4 valve related reinterventions (3 structural valve deterioration (SVD) requiring TAVI Valve-in-Valve, 1 endocarditis) occurred. Conclusions With their good clinical outcomes, sutureless prostheses represent a good alternative for patients with small annuli, who are at high risk for annular enlargement and anticoagulant therapy. Trial registration Study number 587/2015.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged, 80 and over / Annuli / Anticoagulants / Aorta / Aortic valve / Aortic Valve - surgery / Aortic Valve Stenosis - surgery / Biological heart prosthesis / Cardiac Surgery / Cerebral infarction / Coronary artery bypass / Endocarditis / Fatalities / Female / Follow-up outcome / Follow-Up Studies / Heart attacks / Heart failure / Heart Valve Prosthesis / Heart Valve Prosthesis Implantation - methods / Heart valves / Hemodynamics / Humans / Implants, Artificial / Leakage / Male / Medicine / Medicine & Public Health / Mortality / Myocardial infarction / Pacemakers / Patients / Patient‒prosthesis mismatch / Prognosis / Prostheses / Prosthesis / Prosthesis Design / Prosthetics / Registries / Sutureless aortic valve / Sutureless Surgical Procedures - methods / Sutures / Thoracic Surgery / Thorax / Treatment Outcome