Aortic Valve Replacement in Geriatric Patients: Are Sutureless Valves the Way to go?

Objective: Aortic valve replacement (AVR) in geriatric patients (>75 years) is a challenge. We compared our results of AVR with sutureless valves against those with conventional biological valves.

Methods: Between 4/2007 and 02/2012, 275 isolated AVR were performed in geriatric patients at our center. In 178 patients (108 females, age 79.9 ± 3.56 years) conventional valves (Group A) and in 97 patients (71females, age 80.3 ± 3.60 years) sutureless valves (Group B) were implanted. The NYHA status of group A was 2.6 ± 0.6 and that of group B 2.8 ± 0.56 (p = 0.01), respectively. Minimally access surgery was performed in 14.0% (n = 25) of the patients in group A and 90.7% (n = 88) of the patients in group B, respectively. Pre-operative mean gradients were 47.9 ± 14.9 mm Hg (group A) and 50.3 ± 19.3 mm Hg (group B), p = 0.18. Follow-up was conducted 1256 ± 520.5 days postoperative for the conventional valves and 705 ± 473.4 days postoperative for the sutureless valves.

Results: The CPB and X-Clamp times of group A were 73.19 ± 15.6 and 49.2 ± 12.4 minutes and 64.46 ± 22.10 and 34.12 ± 9.4 minutes in group B (p< 0.001). 30-day mortality was 2.2% (n = 4) in group A and 0% in group B. Post-operative mean gradients were 12.9 ± 4.9 mm Hg (group A) and 13.5 ± 4.9 mm Hg (group B) (p = 0.31). At follow-up, group B had a mean gradient of 12.4 ± 5.2 mm Hg and group A of 14.49 ± 6.8 mm Hg (p = 0.06).

Conclusion: This study highlights the advantages of sutureless valves for geriatric patients. This is reflected in shorter Xclamp and CPB times even though most of these patients were operated via a minimally invasive access. These valves may also enable broader application of minimally invasive AVR