Outcomes of Enhanced Recovery After Sutureless Aortic Valve Replacement in Older Patients

Background/Aim In surgery, enhanced recovery protocols including minimally invasive surgery and the use of sutureless valves can play an important role to decrease invasiveness and improve outcomes, certainly in older patients. The objective of this study was to analyze outcomes of enhanced recovery after cardiac surgery (ERACS) to older patients after sutureless AVR (SU AVR). Materials and Methods We analyzed all patients between 2007 and 2022 who underwent SU-AVR and were included in the ERACS program. The primary outcome was 30-day mortality. Secondary outcome were 5-year survival, postoperative complications and hemodynamic performance. Results We identified 237 ERACS patients with a median age of 78 years and the median EuroSCORE II was 2.2%. Isolated AVR accounted for 80.2% of cases, and a minimally invasive approach was used in 70.5% of patients. Thirty-day mortality was 0.4% with a stroke rate of 0.8%. Valves performed well at discharge with a peak and mean gradient of 22.5 mmHg (IQR, 19-29 mmHg) and 12 mmHg (IQR, 10-16 mmHg), respectively. Paravalvular leakage > 1/4 occurred in 0.8% and new pacemaker implantation was needed in 5.1%. Five-year survival was 90.1%. Conclusions In a cohort with most patients older than 75 years old, we observed very low rates of both 30-day mortality and stroke, good hemodynamic performance of the sutureless valve and low rates of paravalvular leak or pacemaker need. Sutureless AVR facilitates minimal access surgery and allows for application of a ERACS regime in a wide variety of patients, even in older patient cohort.