Minimal Invasive and Sutureless Technology: Are These Advantages for Patients Undergoing Aortic Valve Replacement?

Objectives: Minimal invasive aortic valve replacement (AVR) could cause less morbidity than conventional surgery, but up to now strong clinical advantages are not yet demonstrated. The use of sutureless aortic valve prostheses in addiction could reduce the surgical time. However, whether shorter surgical time results in improved patient outcome remains to be determined.

Methods: From June 2007 to June 2015, 627 patients underwent elective isolated aortic valve replacement through upper ministernotomy either with a sutureless valve (group A, n = 206) or a stented aortic bioprosthesis (group B, n = 247). 174 patients underwent isolated aortic valve replacement through full sternotomy with a stented bioprosthesis (group C). A intrahospital clinical outcome comparison between these 3 groups was performed.

Results: The group A was the eldest (Table 1). Aortic X-clamp, cardiopulmonary bypass and operation times were shorter in group A than in B and C. As expected, X-clamp time in minimal invasive approach without sutureless was prolonged (Table 1). MIC approach enables an advantage for bleeding complications in terms of postoperative drainage and need of transfusions (Table 1). MIC-Sutureless showed a protective effect on renal function but a higher incidence of permanent pacemaker implantation (Table 1). We recorded no difference in terms of postoperative cardiac enzymes, no difference in oro-tracheal intubation time as well hospital/ICU stay (Table 1). There was no statistical difference in terms of mortality, stroke and wound infection (Table 1).

Table 1

Conclusions: MIC-approach allowed a protective effect on bleeding complication but is time demanding. MIC-Sutureless AVR was associated with significant shorter surgical times compared with stented bioprostheses. Although sutureless-AVR patients were significantly older, mortality and renal outcome were comparable with stented AVR groups.