1. Introduction
SAVR performed by median sternotomy has been the surgical standard of care for lesions of the aortic valve (1). Elective SAVR is associated with low morbidity, mortality and results in significant improved quality of life (2).
According to the society of thoracic surgeon (STS) database, the operative risk of SAVR has dramatically improved in the last decade, showing reduction in mortality from 4.3% to 2.6% (3).
In the past few years, the incidence of degenerative aortic valve disease has increased as a consequence of increased life expectancy (4). These patients of AS are elderly patients with severe co morbidities, leading to an increase operative risk and inherent higher morbidity and mortality risks (5).
In recent years, transcatheter aortic valve implantation (TAVI) has emerged as MI approach to treat these high risk patients. The PARTNER 1 and 2 studies have demonstrated the superiority of TAVI or medical therapy in patients deemed to be inoperable and non-inferiority of TAVI in high and intermediate risk patients when compared with SAVR (6, 7). Presently TAVI has moved to even in the low risk patients. (8) Despite improvement in design of Transcatheter valves, rate of pacemaker implantations, vascular complications and PVL are still higher with TAVI in comparison to SAVR (9).
Another inherent problem of transcatheter valve is crimping, which can lead to the damage of bio-prosthetic valve (10) and may effect long-term durability. Also, in Indian scenario, the cost of transcatheter valve is another important factor, limiting the use of TAVI in larger population (11).
This changing management for intervention on AV disease towards less invasive TAVI approach has led to the development of ways of reducing the physiological impact of SAVR. Sutureless implantation can reduce x-clamp and CPB time. It also facilitates minimally invasive aortic valve replacement (MIAVR), whereas the lack of stent and swing ring enables improved hemodynamics (12, 13). Current clinical experience demonstrates promising results for Sutureless valve technologies, such as reduced cardiac ischemia, CPB times and facilitated MI procedures. (14)
This study reports the largest single center experience of Sutureless Perceval valve along with its hemodynamic performance and the clinical outcome during early follow-up in Indian patients.