Objective: Analysis of outcome after minimally invasive sutureless AVR in a real-world older patient population.

Methods: Monocentric, retrospective study. Patient inclusion criteria were sutureless aortic valve replacement using the Perceval® valve and a minimally invasive approach. Patients were included between January 2007 and June 2022. During this period, both the implant sizing technique and valve type evolved.

Results: In total, 394 patients received a sutureless valve via MICS. The median age of this population was 80 years (75 – 83) with 51% octogenarians. The median EuroSCORE II was 2.5% (1.7 – 3.7). Nearly all patients were treated for a single aortic valve replacement (97.7%). Procedure times were short with a median cardiopulmonary bypass time of 61 (51 – 72) min. and cross-clamp time of 38 (32 – 45) min.

Evolution in valve use: In 2017, an implant sizing shift was introduced and in 2020, the Perceval PLUS. Both changes influencing pacemaker implantation rate and transprosthetic gradients.

Conclusion: In an older patient population, we still observe very low rates of major postoperative complications with 0.5% in-hospital mortality after minimally invasive sutureless AVR. Pacemaker rate and hemodynamic performance improved with the valve evolutions, further improving patient outcome.