Sutureless aortic valve and post-operative atrial fibrillation: Five-year outcomes from a propensity matched cohort study.

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.