Setting Up A Minimally Invasive Surgery Program:  The Sutureless Solution

Background and aim of the study: Minimally invasive approaches for aortic valve replacement (AVR) are clinically beneficial for patients but are more technically demanding for surgeons. Sutureless AVR is a new and minimally invasive approach. The study aim was to evaluate initial AVR outcomes in patients aged >75 years after setting up a sutureless minimally invasive surgery program. Methods: Between January 2014 and December 2015, a total of 108 patients aged >75 years with indication of isolated elective AVR received a sutureless bioprosthesis using the minimally invasive approach (sutureless group). The latter group was compared with a second group of patients (n = 115) who received a stented valve through a full median sternotomy (stented group) at the authors’ institution between January 2012 and December 2013. After propensity score matching, 95 pairs of patients were available for analysis. Results: Preoperative demographic variables were similar between the matched groups. The aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times were each shorter in the sutureless group (p <0.01). Perioperative mortality was 1% in the stented group, but no mortality occurred in the sutureless group (p = 0.32). Early postoperative extubation, intensive care unit and hospital stays, need for transfusion, and overall hospital stay were lower in the sutureless group. Frequency of pacemaker implantation was higher in the sutureless group than in the stented group (8.3% versus 1.9%; p = 0.05). Aortic transvalvular gradients were lower in the sutureless group (p = 0.01). Conclusion: In the authors’ experience, the sutureless aortic valve was a useful tool for establishing a minimally invasive AVR program. The technique was safe, and the shorter ACC and CPB times increased the likelihood of early extubation, reduced the need for blood transfusions, and demonstrated good hemodynamic performance. Patients who underwent sutureless AVR showed an increased need for pacemaker implantation.