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Sutureless Valve in Aortic Valve Reoperation: Results from an International Prospective Registry
Mattia Glauber1, William Kent2, George Asimakopoulos3, Giovanni Troise4, Josep Maria Padrņ5, Alistair Royse6, Jean-Marc Marnette7, Philippe Noirhomme8, Max Baghai9, Michael Lewis10, Antonio Miceli1, Lorenzo Di Bacco1, Marco Solinas11.
1Istituto Clinico Sant'Ambrogio, Milano, Italy, 2Libin Cardiovascular Institute and University, Calgary, AB, Canada, 3Royal Brompton Hospital, London, United Kingdom, 4Fondazione Poliambulanza, Brescia, Italy, 5Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 6Royal Melbourne Hospital, Melbourne, Australia, 7CHR de Namur, Namur, Belgium, 8Saint Luc University Clinic, Brussels, Belgium, 9King's College Hospital, London, United Kingdom, 10Brighton and Sussex University Hospitals, Sussex, United Kingdom, 11Pasquinucci Heart Hospital, Massa, Italy.

Objective: To report the early and mid term results of patients who underwent aortic valve replacement (AVR) with a sutureless prosthesis in case of aortic valve reoperation (REDO) from an International prospective registry. Methods: Between March 2011 and September 2018, among the 957 patients included in the prospective observational SURE-AVR registry a total of 59 patients underwent REDO AVR with self-expandable sutureless aortic bioprosthesis in 17 International institutions. Preoperative, periprocedural and follow-up clinical and echocardiographic parameters, as well as clinical outcomes, were analyzed for all patientsResults: Patient age was 71.1 ± 10.3 years; 42.4% were female. Median logistic EuroSCORE II was 11.3%. The indications for REDO surgery were infective endocarditis (16.9%) and bioprosthetic structural valve dysfunction and degeneration (83.1%) and were performed in patients previously implanted with bioprostheses (n=47), mechanical valves (n=10) or transcatheter valves (n=2). Surgery was performed through median sternotomy in 52 (88.1%), mini-sternotomy in 3 (5.1%) and mini-thoracotomy in 4 (6.8%) cases. Concomitant procedures were performed in 20 cases (33.9%). Median intensive care unit stay was 2 days. Five-year survival was 96.3%. The mean transvalvular gradient at 1 year follow-up was 11.2 ± 5.2 mmHg. Early and late complications are reported in Table 1.Conclusions: Sutureless AVR in high-risk REDO surgery procedure is a safe and effective alternative to traditional AVR or transcathether valve in valve approach, providing satisfactory hemodynamic performance with excellent clinical recovery, both in the early and at mid-term follow up. Although the limited sample size, these results are encouraging and support the use of sutureless valves in the frame of REDO AVR surgery.

Early and late results
Early (≤ 30 days) N (% on 59 patients)Late (> 30 days) N (% on 44 patients)
Non cardiovascular death2 (3.4%)1 (2.3%)
Explant1 (1.7%)0
Disabling stroke01 (2.3%)
Non-disabling stroke1 (1.7%)0
Transient ischemic attack1 (1.7%)1 (2.3%)
Paravalvular leak2 (3.4%) (1+)1 (2.3%) treated with TAVI
Endocarditis01 (2.3%)
Pacemaker implantation4 (6.8%)2 (4.5%)
Structural valve deterioration01 (2.3%)

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