Sutureless Bioprostheses - The Barts Experience

Objective: Analysis of our experience and results with the use of sutureless bioprostheses. Methods: We retrospectively analysed records from February 2014 till November 2018. Data was extracted from electronic case notes and local PATS database, including pre-operative demographics, EuroSCORE, operative details and post-operative haemodynamic profiles on echocardiography and major adverse cardiovascular and cerebrovascular events. Results: We performed 181 cases, mean age was 76.2±4.7, mean logistic EuroSCORE was 9.4±3.4, mean EuroSCORE2 was 4.6±2.8. The LivaNova Perceval prosthesis was used in 158 (87.3%) cases and the Edwards Intuity prosthesis used in 23 (12.7%) cases. The operations performed were isolated AVR in 102 (56%), AVR+CABG in 56 (31%) and AVR+MVR+/-CABG in 23 (13%). AVR was performed via hemi-sternotomy in 20 (19.6%) and right anterior thoracotomy in 24 (23.5%) cases. Mean cardiopulmonary bypass and aortic cross clamp times were 99.4±11.3 and 69.3±10.2 in the overall cohort and 73.2±9.5 and 45.7±8.5 in the isolated AVR group. There were 8 (4.4%) in-hospital mortalities, 2 (1.1%) cerebrovascular accidents and 6 (3.3%) permanent pacemaker insertions. Post-operative valve gradients were 9.74±2.3mmHg (mean) and 18.5±8.5mmHg (peak), with an incremental reduction with increasing prosthesis size. There were 5 (2.8%) mild and 7 (3.9%) trivial paravalvular leaks on post-operative echocardiography. The mean length of hospital stay was 5.8±4.2 days. These outcomes were comparable or superior to an equivalent cohort undergoing conventional sutured AVR. Conclusions: Our results demonstrate the excellent safety and haemodynamic performance of sutureless bioprostheses in this patient cohort as well as their use in the development of a minimally invasive program.