Sutureless aortic valve replacement with the 3f Enable aortic bioprosthesis.

PURPOSE: Important comorbid conditions in elderly patients referred for aortic valve replacement require alternative treatment options with possible reduction of the extracorporeal circuit time and reliable hemodynamic features. We report on clinical experiences with the sutureless, nitinol-stented 3f Enable (ATS Medical, Minneapolis, MN) aortic valve prosthesis in 32 patients. DESCRIPTION: The procedure was performed using cardiopulmonary bypass with cardioplegic arrest. After resection of the stenotic aortic valve and debridement of the annulus, the valve was inserted and released. Mean age was 78 +/- 3; mean logistic Euroscore was 13.7. Concomitant procedures were mitral valve and tricuspid valve repair (n = 1), coronary artery bypass graft (n = 9), and subvalvular myectomy (n = 3). EVALUATION: Implantation of the valve required 9 +/- 5 minutes. Cardiopulmonary bypass and aortic cross-clamp time were 87 +/- 16 and 55 +/- 11 minutes for stand-alone procedures. Combined procedures required 126 +/- 42 and 84 +/- 28 minutes, respectively. Two patients were abandoned intraoperatively and converted to standard procedures due to misalignment of the valve. In the other 30 patients, no paravalvular leakage was detected. The transvalvular gradient at discharge was 9 +/- 6 mm Hg (mean) and 18 +/- 9 mm Hg (peak). Six months after surgery, gradients were 10 +/- 4 mm Hg (mean) and 18 +/- 6 mm Hg (peak).
CONCLUSIONS: Sutureless valve implantation is feasible and safe with the 3f Enable (ATS Medical) bioprosthesis. Reduction of cardiopulmonary bypass and aortic cross-clamp time seems to be possible with increasing experience. Hemodynamic data are promising with low gradients at discharge and after 6 months.