Multi-Centre experience of sutureless prostheses inside degenerated stentless aortic valves and bioroots.

OBJECTIVES: Patients with failed stentless aortic prostheses are a challenging population to treat, as re-operative procedures may be complex and catheter based treatments are associated with a high rate of proecedural events. Re-operative surgery using sutureless valves may be an alternative.

METHODS: In this multicentre experience we assess outcomes of 17 patients who underwent re-operative surgery using the Perceval valve (Corcym UK Limited, London, UK) insideFreestyle prosthesis (Medtronic Inc., Dublin, Ireland) or bioroots from 2018-2023.

RESULTS: Mean age was 71.1 ± SD 15.1 years and mean EuroSCORE II was 13.5 ± 15.8 %, STS Score was 5.9 ± 11.7%. Mean tranvalvular gradient at baseline was 25.3 ± 19.9 mmHg and left ventricular ejection fraction was 53.5 ± SD 8.5%. In 70.6% (12/17), moderate or severe aortic regurgitation was present. Implant success was 100%. Aortic cross-clamp time was 44.5 ± SD 23.6 min. No patient needed a pacemaker and no >mild paravalvular regurgitation occurred. Mean gradient was 12.5 ± 4.7 mmHg. 30-day mortality was 5.9% (1/17).

CONCLUSIONS: Rate of mortality was lower than predicted by EuroSCORE II in these high-risk patients and haemodynamic outcomes were favourable. Heart teams should consider this treatment concept when discussing patients with failed stentless valves or bioroots.