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

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.