Conventional surgical aortic valve replacement (AVR) is the ‘gold standard’ for treatment of severe or symptomatic aortic valve stenosis. The increasing age of patients and increasing comorbidities has led to the development of procedures to minimise operative time and reduce risks of surgery. One method of reducing operative times is the use of sutureless aortic valves (SU-AVR). We examine the current literature surrounding the use of SU-AVR. Alternatives to AVR are SU-AVR, sometimes referred to as rapid deployment valves, or transcatheter aortic valve implantation (TAVI). TAVI has been demonstrated to be superior over medical therapy in patients deemed inoperable and non-inferior in high and intermediate-risk patients compared with surgical AVR. However, the lack of excision of the calcified aortic valve and annulus raises concerns regarding long-term durability and possibly thromboembolic complications. TAVI patients have increased rates of paravalvular leaks, major vascular complications and pacemaker implantation when compared with conventional AVR. SU-AVR minimises the need for suturing, leading to reduced operative times, while enabling complete removal of the calcified valve. The increase in use of SU-AVR has been mostly driven by minimally invasive surgery. Other indications include patients with a small and/or calcified aortic root, as well as patients requiring AVR and concomitant surgery. SU-AVR is associated with decreased operative times and possibly improved haemodynamics when compared with conventional AVR. However, this has to be weighed against the increased risk of paravalvular leak and pacemaker implantation when deciding which prosthesis to use for AVR.
- valve disease surgery
- aortic stenosis
- prosthetic heart valves
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Contributors All authors contributed to the final preparation of the manuscript. RB performed the literature searching and preparation of the initial draft. MAB and NPB both provided additional content and expertise. MJ also contributed to literature review and initial draft and oversaw all work related to the article. MJ is responsible for the overall content of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests MAB receives speaker honoraria and/or consulting fees from Edwards Lifesciences, Medtronic, Abbott (former St Jude Medical) and Cryolife.
Patient consent Not required.
Provenance and peer review Commissioned; externally peer reviewed.