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OBJECTIVES: The development of new percutaneous and surgical techniques has reduced the risk associated with aortic valve replacement procedures. We present the results of a Spanish register after initiating a programme for sutureless prostheses in moderatehigh-risk patients. METHODS: This prospective multicentre study was carried out from November 2013 to November 2016. Data were obtained from 448 patients in whom a Perceval S prosthesis was implanted. RESULTS: The mean age was 79.24 (standard deviation [SD] 4.1) years, and 61.2% were women. The estimated EuroSCORE I log risk was 11.15% (SD 7.6), with an observed mortality of 4.4% (20 patients). Isolated aortic valve replacement was performed on 69.26% of patients, with 64% involving ministernotomy. The incidence of neurological events was 2%, with 2 permanent cerebrovascular accidents, and 41 (9.2%) patients were implanted with a permanent endocavitary pacemaker. At discharge, 12 (2.6%) patients presented minimal periprosthetic leakage, and 4 (0.89%) patients had moderate leakage. There were 3 reinterventions during follow-up (2 endocarditis and 1 dysfunction due to periprosthetic leak progression). The mean gradient at discharge, 6 months and 1 year was 12.94 (SD 5.3) mmHg, 12.19 (SD 4.7) mmHg and 11.77 (SD 4.7) mmHg, respectively; 59.4% of the patients were octogenarians, with a survival rate of 98% at both 6 months and 1 year at discharge. There was neither valve migration nor early structural degeneration. The mean follow-up was 12 ± 3 months. The 6-month and 1-year mortality was 1.4% and 2.1%, respectively. CONCLUSIONS: This is a prospective multicentric study on the largest cohort of patients with sutureless valves conducted in Spain to date. It is a reproducible procedure that has enabled surgery on patients with a moderatehigh risk with low morbidity and mortality, providing good haemodynamic results.

RESUMENReportar el implante de una válvula aórtica sin sutura en un paciente con endocarditis subaguda no diagnosticada. Paciente de 76 años intervenido con el diagnóstico de estenosis aórtica severa degenerativa con abundante calcificación. Semanas anteriores cursó con episodio febril no filiado. Ecocardiografía: Estenosis aórtica severa calcificada. No otras valvulopatías. Cateterismo: Coronarias sin lesiones significativas. Se realiza intervención quirúrgica. Esternotomía media. CEC convencional. Aortotomía trasnversa. Se aprecia desinserción del velo aórtico coronario derecho. Cavidad abscesificada de gran tamaño, con destrucción del anillo a lo largo del velo coronario derecho, con extensión hacia el izquierdo y hacia el septo interventricular. Implante de una válvula sin sutura “Perceval S”. Se comprueba la correcta posición visualmente. Cierre de la aortotomía. Salida de CEC sin complicaciones. Control postoperatorio inmediato con ETE: Válvula aórtica protésica normoposicionada sin regurgitación. Postoperatorio inmediato sin complicaciones, extubado a las 4 horas. Insuficiencia renal transitoria recuperada. Uso de drogas vasoactivas a dosis bajas. Pasa a planta de hospitalización a los 4 días. Es dado de alta a los 9 días a su centro de referencia para continuar tratamiento antibiótico. En los cultivos microbiológicos de la válvula se aisló S. Epidermidis y se puso tratamiento antibiótico específico. El control postoperatorio a los 6 meses: Válvula aórtica protésica en posición correcta, sin insuficiencia aórtica.ConclusionesEl uso de la válvula aórtica protésica sin sutura “Perceval S”, es una posibilidad terapéutica para el tratamiento de la endocarditis aórtica aguda en casos con destrucción parcial anular y subanular.ABSTRACTReport implantation of a sutureless aortic valve in a patient with undiagnosed subacute endocarditis. Patient 76 years involved with the diagnosis of severe aortic stenosis with plenty degenerative calcification. Weeks earlier attended with febrile episode of unknown cause. chocardiography: severe calcific aortic stenosis. No other valve diseases. Catheterization: Coronary without significant injury. Surgery is performed. Median sternotomy. Conventional CPB. Trasnversa aortotomy. Detachment of the right coronary aortic leaflet is appreciated. Large abscess cavity with destruction of the ring along the right coronary leaflet, extending to the left and to the interventricular septum. Implantation of a sutureless valve “Perceval S”. The correct position is checked visually. Closure of the aortotomy. CEC output without complications. Control immediate postoperative TEE: prosthetic aortic valve without regurgitation normoposicionada. No immediate postoperative complications extubated 4 hours. Transient renal failure recovered. Vasoactive drugs at low doses. Spend a ward within 4 days. He was discharged after 9 days to its reference center to continue antibiotic treatment. In microbiological cultures valve S. epidermidis was isolated and put specific antibiotic treatment. The postoperative control after 6 months: prosthetic aortic valve in the correct position without aortic insufficiency.ConclusionsThe use of sutureless prosthetic aortic valve “Perceval S”, is a therapeutic option for the treatment of acute aortic endocarditis in patients with partial annular and subannular destruction.