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.