Aortic valve sutureless bioprothesis. 100 implantations and 10 years of observation

Abstract

Aortic valve replacement has long been recognized as the “gold standard” in the treatment of aortic valve disease. However, an increasing number of patients require combined surgical interventions in addition to aortic valve replacement. Currently, operative mortality in isolated aortic stenosis ranges from 3-8% in low-risk patients younger than 70 years and between 5 and 11% in “elderly patients”, reaching 15% in cases of combined heart interventions. The use of sutureless valves for open implantation requires careful analysis of the short-term and long-term outcomes of their use and comparison with the results of standard prosthetic methods. Material and methods. The study design is a comparative prospective-retrospective study evaluating interventions using diff erent types of biological prostheses for aortic valve disease in combination with associated cardiac pathology and without it. The study included patients over 65 years old with aortic stenosis who underwent aortic valve replacement using sutureless biological prostheses. Key surgical treatment outcomes were compared with data from patients implanted with sewn biological valves. Comparison was made based on intraoperative parameters, the number and nature of postoperative complications, survival, freedom from reoperation, dynamics of transaortic gradient, hemodynamic characteristics throughout the observation period. Results. In the group of patients with implanted sutureless valves, there was a low number of postoperative complications, faster recovery, signifi cantly lower mortality rates, higher freedom from valve-related complications in both short-term and long-term postoperative periods. Conclusions. The use of sutureless prostheses is justifi ed for aortic valve replacement and is safer compared to standard sewn prostheses in the absence of contraindications. Surgical treatment of patients with aortic stenosis using sutureless valves led to signifi cant clinical improvement in most cases, with signifi cantly lower rates of typical complications. The simplicity and reproducibility of the procedure, rapid learning process can undoubtedly contribute to a wider and more active implementation of this technology in clinical practice.