LAUSR

Background and Aim: Minimally invasive approach (MIA) reduces mortality and morbidity in patients referred for aortic valve replacement (AVR). Sutureless technology facilitates MIA. We describe our experience with sutureless Perceval (LivaNova, Italy) aortic bioprosthesis in right anterior minithoracotomy (RAMT) approach. Methods: Between March 2011 and December 2017, 841 patients underwent AVR with Perceval bioprosthesis. 461 patients were operated through RAMT approach. Considering only isolated AVR (530), Perceval in RAMT approach was performed in 87% of patients. Prosthesis sizes implanted were: S (n = 67), M (n = 147), L (n = 218) and XL (n = 29). Concomitant procedures were mitral valve surgery (n = 5), tricuspid valve repair (n = 1), mitral valve repair and tricuspid valve repair (n = 1), and miectomy (n = 2). Mean age was 77.2 ± 6.5, 61.12 % patients were female, and mean logistic EuroSCORE was 12.7 ± 9.9. Results: The 30-day mortality was 0.65% (3/461). Cardiopulmonary bypass and aortic cross-clamp times were 82.3 ± 30.8 and 52 ± 21.6 minutes for stand-alone procedures. In 3 patients appeared early moderate paravalvular leakage required reoperations. Permanent pacemaker implantation within the first 30 days was necessary in 5% of patients. At mean follow-up of 28.6 ± 12.4 months, survival was 97%, freedom from reoperation was 98%, and mean transvalvular pressure gradient was 11.7 ± 5 mmHg. Conclusions: AVR with Perceval bioprosthesis in RAMT approach is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance. Sutureless technology facilitates RAMT approach.