Results from a prospective international real-world registry of sutureless aortic bioprosthesis by a minimally invasive approach

Introduction The aim of this study was to report clinical and hemodynamic results from a real-world registry of aortic valve replacement (AVR) with the Perceval sutureless bioprosthesis, comparing mini-sternotomy (MS) versus mini-thoracotomy (MT) approach. Methods This prospective international registry enrolled 1,652 patients across 55 institutions between 2011 and 2021. Patients undergoing isolated AVR by minimally invasive cardiac surgery approaches were analyzed. Preoperative covariates were adjusted using 1:1 propensity score matching, reaching a final cohort of 261 patients for each approach. Results Isolated AVR via minimally invasive approaches was performed in 710 patients—406 in MS and 304 in MT. After matching, the baseline characteristics were similar between the two groups, except for the preoperative NYHA class distribution. MT was associated with shorter intensive care unit and hospital stays ( p = 0.001 and p = 0.050, respectively), but with higher cross-clamp and cardiopulmonary bypass times compared to MS (0.001). Within 30 days, one cardiovascular death occurred in the MS group, while 4 (1.5%) reinterventions were reported in the MT group. Pacemaker implantation was required in 5 (1.9%) patients in the MS group and 14 (5.4%) patients in the MT group, with no statistically significant difference. In the matched cohort, survival probability for late events showed no difference between surgical approaches. Mean pressure gradients remained stable during follow-up, with no difference between the groups. Discussion Our propensity-matched analysis demonstrates that the use of Perceval in minimally invasive approaches is associated with low perioperative complication rates. Sutureless implanted in MT has lower intensive care and in-hospital stay without significant differences in long-term clinical and echocardiographic outcomes.