Sutureless Aortic Valve Implantation

  • Theodor Fischlein
  • Giuseppe SantarpinoEmail author


It was recently reported an increase in the prevalence of patients with valvular heart disease eligible for aortic valve replacement (AVR) due to the increase in life expectancy of the general population [1]. However, the wide spectrum of patients with older age and comorbidities is associated with increased surgical risk and stimulated the development of minimally invasive aortic valve procedures that can reduce the mortality and morbidity risk even in elderly patients. Transcatheter aortic valve implantation (TAVI) procedures have been developed and extensively used in high-risk patients considered to be not eligible for standard surgery using cardiopulmonary bypass [2]. To the same extent, older patients pose significant challenge to modern cardiac surgery, even in the absence of specific high-risk features: in these patients less invasive procedures are desirable to achieve a reduction in the global risk profile and a better surgical outcome [3]. In this population, a patient-oriented assessment is usually performed since standardized guidelines on the use of a “minimally-invasive” approaches are not available, and there is substantial inter-center heterogeneity in the clinical implementation of this approach.


  1. 1.
    Bridgewater B, Gummert J, Kinsman R, Walton P. Towards global benchmarking: the fourth EACTS adult cardiac surgical database report. Henley‐on‐Thames: Dendrite Clinical Systems; 2010.Google Scholar
  2. 2.
    Zahn R, Gerckens U, Grube E, Linke A, Sievert H, Eggebrecht H, et al. German transcatheter aortic valve interventions‐registry investigators. Transcatheter aortic valve implantation: first results from a multi‐centre real‐world registry. Eur Heart J. 2011;32:198–204.CrossRefGoogle Scholar
  3. 3.
    Ruttmann E, Gilhofer TS, Ulmer H, Chevtchik O, Kocher A, Schistek R, et al. Propensity score matched analysis of aortic valve replacement by mini‐thoracotomy. J Heart Valve Dis. 2010;19:606–14.Google Scholar
  4. 4.
    Phan K, Xie A, Di Eusanio M, Yan TD. A meta-analysis of minimally invasive versus conventional sternotomy for aortic valve replacement. Ann Thorac Surg. 2014;98:1499–511.CrossRefGoogle Scholar
  5. 5.
    Santarpino G, Pfeiffer S, Concistré G, Fischlein T. Perceval S aortic valve implantation in mini-invasive surgery: the simple sutureless solution. Interact Cardiovasc Thorac Surg. 2012;15:357–60.CrossRefGoogle Scholar
  6. 6.
    D'Onofrio A, Messina A, Lorusso R, Alfieri OR, Fusari M, Rubino P, et al. Sutureless aortic valve replacement as an alternative treatment for patients belonging to the “gray zone” between transcatheter aortic valve implantation and conventional surgery: a propensity-matched, multicenter analysis. J Thorac Cardiovasc Surg. 2012;144:1010–6.CrossRefGoogle Scholar
  7. 7.
    Santarpino G, Pfeiffer S, Concistré G, Fischlein T. A supra-annular malposition of the Perceval S sutureless aortic valve: the ‘χ-movement’ removal technique and subsequent reimplantation. Interact Cardiovasc Thorac Surg. 2012;15:280–1.CrossRefGoogle Scholar
  8. 8.
    Santarpino G, Pfeiffer S, Jessl J, Dell’Aquila AM, Pollari F, Pauschinger M, et al. Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: a propensity-matched analysis of 2 strategies in high-risk patients. J Thorac Cardiovasc Surg. 2014;147:561–7.CrossRefGoogle Scholar
  9. 9.
    Shrestha M, Khaladj N, Bara C, Hoeffler K, Hagl C, Haverich A. A staged approach towards interventional aortic valve implantation with a sutureless valve: initial human implants. Thorac Cardiovasc Surg. 2008;56:398–400.CrossRefGoogle Scholar
  10. 10.
    Santarpino G, Pfeiffer S, Concistré G, Grossmann I, Hinzmann M, Fischlein T. The Perceval S aortic valve has the potential of shortening surgical time: does it also result in improved outcome? Ann Thorac Surg. 2013;96:77–81; discussion 81-2.CrossRefGoogle Scholar
  11. 11.
    Pollari F, Santarpino G, Dell’Aquila AM, Gazdag L, Alnahas H, Vogt F, Pfeiffer S, Fischlein T. Better short-term outcome by using sutureless valves: a propensity-matched score analysis. Ann Thorac Surg. 2014;98:611–6; discussion 616-7.CrossRefGoogle Scholar
  12. 12.
    Fischlein T, Pfeiffer S, Pollari F, Sirch J, Vogt F, Santarpino G. Sutureless valve implantation via mini J-sternotomy: a single center experience with 2 years mean follow-up. Thorac Cardiovasc Surg. 2015;63:467–71.CrossRefGoogle Scholar
  13. 13.
    Gilmanov D, Miceli A, Ferrarini M, Farneti P, Murzi M, Solinas M, Glauber M. Aortic valve replacement through right anterior minithoracotomy: can sutureless technology improve clinical outcomes? Ann Thorac Surg. 2014;98:1585–92.CrossRefGoogle Scholar
  14. 14.
    Miceli A, Santarpino G, Pfeiffer S, Murzi M, Gilmanov D, Concistré G, Quaini E, Solinas M, Fischlein T, Glauber M. Minimally invasive aortic valve replacement with Perceval S sutureless valve: early outcomes and one-year survival from two European centers. J Thorac Cardiovasc Surg. 2014;148:2838–43.CrossRefGoogle Scholar
  15. 15.
    Dalén M, Biancari F, Rubino AS, Santarpino G, De Praetere H, Kasama K, Juvonen T, Deste W, Pollari F, Meuris B, Fischlein T, Mignosa C, Gatti G, Pappalardo A, Sartipy U, Svenarud P. Ministernotomy versus full sternotomy aortic valve replacement with a sutureless bioprosthesis: a multicenter study. Ann Thorac Surg. 2015;99:524–30.CrossRefGoogle Scholar
  16. 16.
    Dalén M, Biancari F, Rubino AS, Santarpino G, Glaser N, De Praetere H, Kasama K, Juvonen T, Deste W, Pollari F, Meuris B, Fischlein T, Mignosa C, Gatti G, Pappalardo A, Svenarud P, Sartipy U. Aortic valve replacement through full sternotomy with a stented bioprosthesis versus minimally invasive sternotomy with a sutureless bioprosthesis. Eur J Cardiothorac Surg. 2015.; pii: ezv014. [Epub ahead of print].Google Scholar
  17. 17.
    Laborde F, Fischlein T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, Madonna F, Meuris B, Haverich A, Shrestha M, Cavalier Trial Investigators. Clinical and haemodynamic outcomes in 658 patients receiving the Perceval sutureless aortic valve: early results from a prospective European multicentre study (the Cavalier Trial). Eur J Cardiothorac Surg. 2015;49(3):978–86.CrossRefGoogle Scholar
  18. 18.
    Shrestha M, Fischlein T, Meuris B, Flameng W, Carrel T, Madonna F, Misfeld M, Folliguet T, Haverich A, Laborde F. European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patients. Eur J Cardiothorac Surg. 2015;49(1):234–41.CrossRefGoogle Scholar
  19. 19.
    Rubino AS, Santarpino G, De Praetere H, Kasama K, Dalén M, Sartipy U, Lahtinen J, Heikkinen J, Deste W, Pollari F, Svenarud P, Meuris B, Fischlein T, Mignosa C, Biancari F. Early and intermediate outcome after aortic valve replacement with a sutureless bioprosthesis: results of a multicenter study. J Thorac Cardiovasc Surg. 2014;148:865–71.CrossRefGoogle Scholar
  20. 20.
    Mazine A, Teoh K, Bouhout I, Bhatnagar G, Pelletier M, Voisine P, Demers P, Carrier M, Bouchard D. Sutureless aortic valve replacement: a Canadian multicentre study. Can J Cardiol. 2015;31:63–8.CrossRefGoogle Scholar
  21. 21.
    Santarpino G, Pfeiffer S, Concistrè G, Fischlein T. REDO aortic valve replacement: the sutureless approach. J Heart Valve Dis. 2013;22:615–20.PubMedGoogle Scholar
  22. 22.
    Folliguet TA, Laborde F. Sutureless Perceval aortic valve replacement in aortic homograft. Ann Thorac Surg. 2013;96:1866–8.CrossRefGoogle Scholar
  23. 23.
    Villa E, Messina A, Cirillo M, Brunelli F, Mhagna Z, Dalla Tomba M, Troise G. Perceval sutureless valve in freestyle root: new surgical valve-in-valve therapy. Ann Thorac Surg. 2013;96:e155–7.CrossRefGoogle Scholar
  24. 24.
    Durand E, Tron C, Eltchaninoff H. Emergency transcatheter aortic valve implantation for acute and early failure of sutureless Perceval aortic valve. Can J Cardiol. 2015;31:1204.e13–5.CrossRefGoogle Scholar
  25. 25.
    Moriggia S, Trumello C, Buzzatti N, Iaci G, Di Giannuario G, Alfieri O. Aortic sutureless Perceval valve for small root in concomitant mitral valve replacement. J Heart Valve Dis. 2015;24:187–9.PubMedGoogle Scholar
  26. 26.
    Minh TH, Mazine A, Bouhout I, El-Hamamsy I, Carrier M, Bouchard D, Demers P. Expanding the indication for sutureless aortic valve replacement to patients with mitral disease. J Thorac Cardiovasc Surg. 2014;148:1354–9.CrossRefGoogle Scholar
  27. 27.
    Santarpino G, Pfeiffer S, Fischlein T. Perceval sutureless approach in a patient with porcelain aorta unsuitable for transcatheter aortic valve implantation. Int J Cardiol. 2012;155:168–70.CrossRefGoogle Scholar
  28. 28.
    Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002;106:3006–8.CrossRefGoogle Scholar
  29. 29.
    Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;21:1597–607.CrossRefGoogle Scholar
  30. 30.
    Flameng W, Herregods MC, Hermans H, Van der Mieren G, Vercalsteren M, Poortmans G, et al. Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes. J Thorac Cardiovasc Surg. 2011;142:1453–7.CrossRefGoogle Scholar
  31. 31.
    Santarpino G, Pfeiffer S, Jessl J, Dell’Aquila A, Vogt F, von Wardenburg C, et al. Clinical outcome and cost analysis of sutureless versus transcatheter aortic valve implantation with propensity score matching analysis. Am J Cardiol. 2015;116:1737–43.CrossRefGoogle Scholar
  32. 32.
    Santarpino G, Fischlein T, Pfeiffer S. 1-Year results from the NOTION randomized clinical trial: no news is good news? J Am Coll Cardiol. 2015;66:979.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Paracelsus Medical UniversityNurembergGermany
  2. 2.Città di Lecce HospitalGVM Care and ResearchLecceItaly

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