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Sutureless aortic valve replacement in high-risk patients with infective endocarditis

Mustafa Mert Ozgur¹, Tanıl Ozer¹, Mehmet Aksut¹, Baris Gurel¹, Hakan Hancer¹, Ayhan Gunes¹, Davut Cekmecelioglu², Ozge Altas¹, Sabit Sarıkaya¹, Kaan Kırali<sup>1

1</sup>Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, İstanbul, Türkiye
²Department of Cardiac Surgery, Cleveland Clinic, Cleveland, USA

Keywords: Aortic valve replacement, heart valve, infective endocarditis, prosthesis

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Objectives: This study aims to investigate whether sutureless aortic valve replacement (AVR) is a safe and technically feasible method in patients with infective endocarditits (IE).

Patients and methods: Between September 2019 and March 2023, a total of 10 consecutive patients (4 males, 6 females; mean age: 61.5±17.7 years; range, 29 to 80 years) who underwent sutureless AVR due to aortic valvular IE were retrospectively analyzed. Sutureless AVR was preferred in patients in whom suturing became complex after radical debridement. The pre, peri-, and postoperative results, and follow-up data of the patients were evaluated.

Results: The mean EuroSCORE was 23.85±20.4. The mean ejection fraction was 55.5±12.2%. Seven (70%) patients had prosthetic valve endocarditis, and three (30.0%) patients had native valve endocarditis. Eight (80%) patients had a history of cardiovascular surgery. Concomitant cardiac intervention was performed in four patients. Periprocedural mortality was observed in two patients. None of the patients required permanent pacemaker implantation. Infective endocarditis developed in one patient during follow-up, but reintervention was not needed.

Conclusion: Our study results suggest that sutureless AVR can yield favorable outcomes with low paravalvular leak rates and satisfactory hemodynamic performance and with no major adverse event in IE. We advocate the consideration of sutureless aortic valve replacement as a viable alternative in the management of IE, emphasizing the importance of meticulous execution and expertise to achieve favorable results.

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