Sutureless Aortic Valve Replacement as a Bailout Strategy for Type A Aortic Dissection: 2 Case Reports

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Type A aortic dissection (n=2). Intervention: Sutureless aortic valve replacement (Perceval Plus). Primary outcome: Successful deployment and valve function.

Q: What does this research mean for the field?

Sutureless aortic valve replacement is a viable, time-saving bailout strategy after failed valve repair in selected type A aortic dissection patients with a stabilized proximal aorta. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Sahri Kim; Jae‐Joong Kim

doi:10.5090/jcs.26.096

September 30, 2026The Korean Journal of Thoracic and Cardiovascular SurgeryOpen Access

Sutureless Aortic Valve Replacement as a Bailout Strategy for Type A Aortic Dissection: 2 Case Reports

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Key result

Sutureless AVR enables successful bailout repair in type A aortic dissection across 2 cases.

n=2

Why the study?

Sutureless AVR is generally avoided in type A aortic dissection due to concerns about inadequate stent fixation in fragile, dissected tissue.

Does sutureless aortic valve replacement provide a viable bailout strategy in patients with type A aortic dissection after failed aortic valve repair?

Key Points

To evaluate the feasibility and safety of deploying a sutureless bioprosthesis as a bailout strategy following failed aortic valve repair in patients with type A aortic dissection.
Reviewed 2 patients (N=2) with type A aortic dissection who received a Perceval Plus sutureless bioprosthesis after failed aortic valve repair.
Evaluated procedural steps including standard ascending aortic graft replacement to create an anchoring landing zone, followed by standard manufacturer sizing and deployment protocols.
Assessed operative cross-clamp times alongside postoperative valve positioning, hemodynamic stability, and adverse events over 7 to 8 months of follow-up.
Conversion to sutureless aortic valve replacement increased aortic cross-clamp time by only 20–23 minutes, approximately half the duration required for conventional sutured replacement.
Postoperative imaging confirmed proper prosthetic valve seating with no paravalvular leakage in either patient.
Hemodynamic function remained stable at 7 and 8 months of follow-up, though 1 patient required permanent pacemaker implantation for conduction disturbance.

Study Design

Type

Case Report (n=2)

Multicenter

No

Structured PICO

Does sutureless aortic valve replacement provide a viable bailout strategy in patients with type A aortic dissection after failed aortic valve repair?

P

Population

Two 75-year-old patients with type A aortic dissection who underwent sutureless aortic valve replacement as a bailout strategy after failed aortic valve repair, followed for 7 to 8 months.

I

Intervention

Sutureless aortic valve replacement (Perceval Plus bioprosthesis) deployed as a bailout strategy after failed aortic valve repair.

O

Outcome

Procedural success, aortic cross-clamp time, valve positioning, and hemodynamic function at follow-up.surrogate

Sutureless aortic valve replacement may serve as a viable, time-saving bailout strategy for selected patients with type A aortic dissection and an intact aortic annulus after failed valve repair.

Limitations

Inclusion of only 2 cases
Single-center design
Short follow-up precluding assessment of long-term durability
Acute and chronic dissections represented distinct clinical scenarios with inherently different tissue quality and operative urgency
inclusion of only 2 cases
single-center design
short follow-up precluding assessment of long-term durability
acute and chronic dissections represented distinct clinical scenarios with inherently different tissue quality and operative urgency

Implication

May support sutureless AVR bailout after failed repair in type A dissection; leaves open safety, durability, and generalizability questions.

Abstract

Sutureless aortic valve replacement (AVR) is generally avoided in type A aortic dissection (TAAD) because fragile, dissected tissue may provide inadequate stent fixation. We describe 2 patients with TAAD in whom a Perceval Plus sutureless bioprosthesis was successfully deployed as a bailout after failed aortic valve repair. In both cases, prior ascending aortic replacement created a stable prosthetic landing zone that allowed reliable radial fixation. Conversion to sutureless AVR increased aortic cross-clamp time by only 20-23 minutes, approximately half the time required for conventional sutured implantation. Postoperative imaging showed appropriate valve positioning without paravalvular leakage, and hemodynamic function remained stable at 7 and 8 months. Sutureless AVR may therefore offer a viable, time-saving bailout strategy for selected patients with TAAD, an intact aortic annulus, and a stabilized proximal aorta.

Discussion

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Cite This Study

Kim et al. (2026) conducted a case report in Type A aortic dissection (n=2). Sutureless aortic valve replacement (Perceval Plus) was evaluated on Successful deployment and valve function. Sutureless aortic valve replacement was successfully deployed as a bailout strategy in two patients with type A aortic dissection, resulting in stable hemodynamic function without paravalvular leakage at 7 to 8 months.

synapsesocial.com/papers/6abe3592bdd7597321d9a496 https://doi.org/10.5090/jcs.26.096

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Sutureless Aortic Valve Replacement as a Bailout Strategy for Type A Aortic Dissection: 2 Case Reports

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Sutureless Aortic Valve Replacement as a Bailout Strategy for Type A Aortic Dissection: 2 Case Reports

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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