Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

Abstract

Sutureless and rapid-deployment bioprostheses have been introduced as alternatives to traditional prosthetic valves to reduce cardiopulmonary and aortic cross-clamp times during aortic valve replacement. These devices have also been employed in extremely demanding surgical settings, as underlined in the present review. Searches on the PubMed and Medline databases aimed to identify, from the English-language literature, the reported cases where both sutureless and rapid-deployment prostheses were employed in challenging surgical situations, usually complex reoperations sometimes even performed as bailout procedures. We have identified 25 patients for whom a sutureless or rapid-deployment prosthesis was used in complex redo procedures: 17 patients with a failing stentless bioprosthesis, 6 patients with a failing homograft, and 2 patients with the failure of a valve-sparing procedure. All patients survived reoperation and were reported to be alive 3 months to 4 years postoperatively. Sutureless and rapid-deployment bioprostheses have proved effective in replacing degenerated stentless bioprostheses and homografts in challenging redo procedures. In these settings, they should be considered as a valid alternative not only to traditional prostheses but also in selected cases to transcatheter valve-in-valve solutions.

Keywords: Sutureless valve prosthesis; challenging operations; rapid-deployment valve prosthesis.

Figure 1

Preoperative computed tomography scan of a 79-year-old man who had undergone a modified Bentall procedure using a 27 mm Prima Plus stentless bioprosthesis, showing the extensively calcified porcine aortic root (*) after 11 years. The porcine aortic valve was replaced with a Perceval M sutureless bioprosthesis.