Sutureless Aortic Valve Replacement: 15-year Experience in 1136 Patients

Purpose The aim of this study was to analyze 15 years of all-comers experience in sutureless valves at our center. Methods In this monocentric, retrospective study, all patients who received a sutureless valve between 2007 and June 2022 at our center were included ( N = 1136). The inclusion criteria were any sutureless aortic valve replacement (AVR), regardless of combined procedures. Follow-up data were included until June 31, 2022. A competing risk analysis using cumulative incidences was used for the long-term endpoints. Results A total of 1136 patients received a sutureless valve, with a median age of 79 years (interquartile range IQR: 75-82) and 50.2% male. The median EuroSCORE II was 4.1 (IQR: 2.4%-7.2%). 44.5% of procedures were single AVR, 27.1% were AVR with coronary artery bypass graft, and 28.1% were multiple concomitant procedures. In-hospital mortality was 3.4% ( n = 39), postoperative complications include 4.2% reoperation for bleeding, a 1.8% stroke rate, and 1.4% need for new dialysis. Survival at 5 years was 71.1% and 25.2% at 10 years. Long-term valve-related events included endocarditis and severe structural valve deterioration (SVD), with an incidence rate of 0.50% for endocarditis and 0.74% for severe SVD. Conclusions Sutureless AVR can be used in various settings, as it is suitable for both minimally invasive single AVR and in difficult combined procedures, where it saves valuable cross-clamp time. Our study shows favorable early and late outcomes with low rates of endocarditis, severe SVD, and need for reintervention.