Two Alternative Sutureless Strategies for Aortic Valve Replacement: A Two-Center Experience

Concistrè, Giovanni MD*; Santarpino, Giuseppe MD*; Pfeiffer, Steffen MD*; Farneti, Pierandrea MD; Miceli, Antonio MD; Chiaramonti, Francesca MD; Solinas, Marco MD; Glauber, Mattia MD; Fischlein, Theodor MD*

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery:
doi: 10.1097/IMI.0000000000000007
Original Articles

Objective: Important comorbid conditions in patients referred for aortic valve replacement (AVR) require less invasive strategies. We describe our initial experience with the Perceval S (Sorin Group, Saluggia, Italy) and 3f Enable (Medtronic, Minneapolis, MN USA) sutureless aortic bioprostheses.

Methods: We compared intraoperative data, postoperative clinical outcomes, and echocardiographic results from patients receiving a Perceval S (P group; n = 97) or a 3f Enable (E group; n = 32) prosthesis in two cardiac surgery departments (Nuremberg, Germany, and Massa, Italy).

Results: Baseline patient characteristics were similar in both groups, except for mean ± SD body surface area (P group = 2.01 ± 2.9 m2, E group = 1.83 ± 3.8 m2; P < 0.001). Sixty-five patients (67%) in the P group and 19 patients (59.5%) in the E group (P = 0.22) underwent minimally invasive AVR with either ministernotomy or right anterior minithoracotomy approach. Concomitant procedures were performed in 37 patients (38%) in the P group and 9 patients (28%) in the E group (P = 0.56). In-hospital mortality was 2%. The mean ± SD prosthesis diameter was 23.5 ± 1.4 mm (P group) compared with 22.1 ± 2 mm (E group) (P < 0.001). In isolated AVR, aortic cross-clamp time was 36 ± 12.7 minutes in the P group and 66 ± 18 minutes in the E group (P < 0.001). At a mean ± SD follow-up of 8.3 ± 4.5 months, survival was 97% (one death in the P group). In five patients (P group = 1, E group = 4), a moderate paravalvular leak was present (P = 0.013). The mean ± SD transvalvular gradient was 9.1 ± 3.3 mm Hg with the Perceval S and 11.2 ± 5.2 mm Hg with the 3f Enable (P = 0.017).

Conclusions: Aortic valve replacement with sutureless aortic bioprosthesis is feasible, also with a minimally invasive approach. The Perceval S showed lower operative times and moderate paravalvular leaks and lower mean transvalvular gradients than did the 3f Enable, related to the larger diameter of the Perceval S implanted. Both prostheses showed an excellent hemodynamic performance. This new technology needs long-term follow-up.

Author Information

From the *Department of Cardiac Surgery - Klinikum Nürnberg, Nuremberg, Germany; and †Department of Cardiac Surgery, Ospedale del Cuore “G. Pasquinucci,” Fondazione Monasterio-CNR, Massa, Italy.

Accepted for publication July 11, 2013.

Giovanni Concistrè and Giuseppe Santarpino contributed equally to this study and should be considered co–first authors.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, May 30–June 2, 2012, Los Angeles, CA USA.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Giovanni Concistrè, MD, Department of Cardiac Surgery - Klinikum Nürnberg, Klinikum Süd, Breslauerstraße 201, 90471 Nuremberg, Germany. E-mail:

©2013 by the International Society for Minimally Invasive Cardiothoracic Surgery