Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2025; 17(4): 102669
Published online Apr 26, 2025. doi: 10.4330/wjc.v17.i4.102669
Sutureless aortic valve and post-operative atrial fibrillation: Five-year outcomes from a propensity matched cohort study
Thomas French, Sanjeet Singh Avtaar Singh, Vincenzo Giordano, Charilaos-Panagiotis Koutsogiannidis, Kelvin Hao Han Lim, Renzo Pessotto, Vipin Zamvar
Thomas French, Sanjeet Singh Avtaar Singh, Vincenzo Giordano, Charilaos-Panagiotis Koutsogiannidis, Kelvin Hao Han Lim, Renzo Pessotto, Vipin Zamvar, Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom
Sanjeet Singh Avtaar Singh, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, United Kingdom
Co-corresponding authors: Thomas French and Sanjeet Singh Avtaar Singh.
Author contributions: French T contributed to conceptualization, methodology, statistical analysis, writing-original draft, writing-review and editing. Singh SSA, Giordano V contributed to supervision, conceptualization, methodology, writing-original draft, writing-review and editing, data curation; Giordano V, Koutsogiannidis CP, Lim KHH, Pessotto R, Zamvar V contributed to writing-review and editing, data curation.
Institutional review board statement: The need for local NHS Research and Ethics Committee approval was evaluated with the NHS Health Research Authority toolkit, which deemed the study would be exempt from local committee review given the anonymised, retrospective nature of the study. Written consent was not sought from study participants.
Informed consent statement: Informed consent was obtained at the time of surgery for use of data for study purposes. A copy of the consent form can be made available at request.
Conflict-of-interest statement: Vipin Zamvar received honoraria from the LivaNova group prior to study commencement. No other authors have a conflict of interest to declare.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: sharing statement: The data supporting the conclusions of this study are available from the corresponding author upon request and subject to our being able to satisfy trust data-confidentiality regulations.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thomas French, MD, Research Fellow, Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom. thomfren12@gmail.com
Received: October 25, 2024
Revised: March 7, 2025
Accepted: March 28, 2025
Published online: April 26, 2025
Processing time: 178 Days and 15.5 Hours
Abstract
BACKGROUND

The Perceval Sorin S (perceval valve) is a sutureless bioprosthetic designed for use in a high-risk cohort who may not be suitable for transcatheter aortic valve implantation or a conventional surgical aortic valve replacement (AVR).

AIM

To compare five-year post-operative outcomes in a cohort undergoing isolated AVR with the perceval valve to a contemporary cohort undergoing surgical AVR with a sutured bioprosthesis.

METHODS

This study was a retrospective, cohort study at a single tertiary unit. Between 2017 and 2023, 982 suitable patients were identified. 174 Perceval valve replacements were matched to 174 sutured valve replacements. Cohort characteristics, intra-operative details, and post-operative outcomes were compared between the two groups.

RESULTS

Time under the aortic cross-clamp (P < 0.001), time on the cardiopulmonary bypass (P < 0.001) and total operative time (P < 0.001) were significantly reduced in the Perceval group. Patients in the Perceval valve group were at a lower risk of postoperative pneumonia [odds ratio (OR) = 0.53 (0.29-0.94)] and atrial fibrillation [OR = 0.58 (0.36-0.93)]. After propensity-matching, all-cause mortality did not significantly differ between the two groups in the five-year follow-up period. Larger valve sizes conferred an increased risk of mortality (P = 0.020).

CONCLUSION

Sutureless surgical AVR (SAVR) is a safe and efficient alternative to SAVR with a sutured bioprosthesis, and may confer a reduced risk of post-operative atrial fibrillation. Clinician tendency towards ‘oversizing’ sutureless aortic valves translates into adverse clinical outcomes. Less time on the cardiopulmonary bypass circuit allows for the treatment of otherwise high-risk patients.

Keywords: Sutureless valves; Aortic valve replacements; Survival; Atrial fibrillation

Core Tip: The use of sutureless aortic valves has been well established in the past decade. However, its midterm outcomes are not fully established in comparison to standard surgical aortic valve replacements (AVR). With the advent of Transcatheter aortic valve insertions, the use of sutureless valves may play a major role especially post transcatheter aortic valve implantation explants. We look at the midterm outcomes compared to standard surgical AVR.