10-years’ experience with the sutureless aortic valve replacement: incidence and predictors for survival and valve durability at follow-up


 
 
 Aortic valve replacement with a sutureless prosthesis (Su-AVR) is an option for patients with severe aortic valve stenosis. However, data regarding long-term outcomes and prosthesis durability are still lacking.
 
 
 
 All consecutive patients who successfully underwent Su-AVR with the Perceval valve in our center between 2010 and 2020 were included in the analysis and followed prospectively with echocardiography. Risk factor analysis was performed to assess variables associated with worse survival and bioprosthetic valve failure.
 
 
 
 Study population consisted of 547 patients: mean age was 76.4 (5.2) years, 51% were female, and mean logistic EuroSCORE was 13% (11). The median survival was 7.76 years (95% CI = 6.9–8.6). Risk factor analysis identified age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03–1.11; p < 0.001), EuroSCORE II (HR 1.08, 1.02–1.13; p < 0.001), baseline dialysis (HR 2.14, 95% CI 1.4–4.4; p = 0.038) and postoperative acute kidney injury ≥2 (HR 8.97, 95% CI 4.58–17.6; p < 0.001) as factors significantly correlated with worse survival. The reported HRs for age are per one year and for EuroSCORE II is one percentage point. Structural valve deterioration (SVD) was observed in 23 patients, of which 19 underwent reintervention (median freedom from SVD 10.3 years). In multivariable Cox analysis, age (HR 0.89, 95% CI 0.82–0.95; p < 0.001) was found to be a significant predictor of SVD. Overall, 1.8% was referred for prosthetic valve endocarditis (confirmed or suspected) during follow-up. One patient showed moderate non-SVD and none developed prosthetic valve thrombosis.
 
 
 
 The sutureless valve represents a reliable bioprosthesis for AVR in patients with a 10-year life expectancy. Younger age at time of implant is the only factor associated with the risk of long-term SVD.
