Sutureless aortic valve replacement

A new aortic valve replacement, that doesn’t require sewing into place, is reducing surgery times and proving to be an innovative alternative to conventional options for treating aortic valve stenosis.

Stenosis due to calcification is the commonest pathology of the aortic valve. When severe it results in hypertrophy (enlargement) of the heart muscle and symptoms such as shortness of breath and chest pain.

Aortic valve replacement (AVR) is the highest standard for treatment of aortic valve stenosis. The procedure normally involves using cardiopulmonary bypass during which the calcified native valve is removed and a prosthetic valve is fixed with multiple sutures. High risk patients benefit from the less invasive transcatheter aortic valve implantation (TAVI).

Sutureless AVR is an alternative to both conventional AVR and TAVI. This new technique, which does not necessitate sewing the new valve into position, has been developed in recent years. The technique has been used extensively in several European centres with excellent results. The Sorin Perceval® sutureless aortic valve is a bovine pericardial valve mounted into an alloy stent that is now being offered to patients at Royal Brompton Hospital.

Technique and advantages

Sutureless AVR with the Perceval® prosthesis still utilises cardiopulmonary bypass so that the native valve is removed in the usual way. The sutureless valve prosthesis is loaded onto a delivery system before it is allowed to expand inside the aortic annulus.

The position of the valve is secured with balloon dilatation and assessed with transoesophageal echocardiography at the end of the procedure. Placement is relatively simple and studies have demonstrated that the time required for the insertion is significantly shorter as compared to a sutured valve.

Importantly, sutureless valves function well without regurgitant blood flow. A significant advantage is the large size of the valve cross-section also known as effective orifice area (EOA). Large EOA allows the heart to contract against low resistance which facilitates quicker reduction of the heart size and improved heart function after surgery.

Who would benefit from sutureless AVR?

Sutureless AVR is an innovative approach for patients who require surgery for aortic valve stenosis. It enables faster implantation with shorter cardiopulmonary bypass and operative time. Patients who are of high risk for complications with severe calcification around their native valve or requiring a small valve prosthesis are particularly likely to benefit from the technique. It is also beneficial in patients undergoing AVR in combination with coronary artery bypass grafting (CABG) as it reduces the already prolonged length of the surgery. Sutureless AVR makes less invasive surgery through partial sternotomy easier. Partial sternotomy avoids destabilisation of the rib cage and allows patients to return to activity quicker.