Key result
Sutureless and self-anchoring aortic valve prostheses reduce cross-clamp times and may be considered the valve of choice for higher-risk geriatric patients ineligible for transcatheter implantation.
Why the study?
Do sutureless or self-anchoring aortic valve prostheses improve surgical outcomes and facilitate minimally invasive approaches in high-risk geriatric patients requiring AVR?
Do sutureless or self-anchoring aortic valve prostheses improve surgical outcomes and facilitate minimally invasive approaches in high-risk geriatric patients requiring AVR?
Sutureless and self-anchoring aortic valves reduce cross-clamp times and facilitate minimally invasive surgery, positioning them as a potential valve of choice for high-risk geriatric patients ineligible for TAVI.
Surgical aortic valve replacement (AVR) is the 'gold standard' for the treatment of aortic valve stenosis. Due to the increasing age of the patient population (reflecting the demographic changes), the use of biological valves has increased over the past years. At the same time, a large proportion of these patients require concomitant surgical procedures in addition to AVR. Although trans-apical or trans-femoral aortic valve implantations (TAVI) have been introduced for high risk patients, they are limited to patients with isolated aortic valve pathology. Therefore, strategies for avoiding long ischemia times, as well as long periods of extra-corporeal circulation (ECC) resulting in reduced peri-operative risks should be welcomed among the surgical community. Modern 'sutureless valves' with reduced cross-clamp and cardio-pulmonary bypass times as a result of the absence of sutures, combined with excellent hemodynamics in the short and mid-term, may be an ideal solution for geriatric patients. Additionally, 'self-anchoring' valves will increase the armament of surgeons in treating 'technically difficult' group of patients needing AVR who have small calcified aortic roots and those coming back after aortic root replacement with homografts. These valves should also expand the application of minimally access AVR. Therefore, the question of whether we need 'self-anchoring valves' is not only redundant, but the time may have come for these type of valves to be considered as the 'valve of choice' for higher risk geriatric patients who may be 'high risk' for conventional valves but not ineligible for TAVIs.
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Malakh Shrestha (2015) conducted an editorial in Aortic valve stenosis. Sutureless or self-anchoring aortic valve prostheses vs. Conventional sutured valves was evaluated. Sutureless and self-anchoring aortic valve prostheses reduce cross-clamp times and may be considered the valve of choice for higher-risk geriatric patients ineligible for transcatheter implantation.