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Sutureless Aortic Valve Replacement

A new generation of tissue (biological) heart valve prosthesis, the Sutureless Valves, have been introduced for patients who suffer from stenotic and mixed stenotic-regurgitant aortic valves that require aortic valve replacement (AVR). These sutureless valves are implanted without the use of stitches that are traditionally necessary to securely anchor the conventional prosthetic valves in place. Instead these sutureless valves are held in place by radial forces produced by either balloon expansion (Edwards Intuity) or by the self-expandable nitinol (a special alloy) valve frame (Sorin Perceval S and Medtronic Enable).

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These valves are also called “Rapid deployment valves”. As there is no need for surgeons to put in and tie down the stitches, the procedure of aortic valve replacement is made simpler and faster. This, in turn results in many benefits including making the operation shorter and safer especially for patients who are high-risk (e.g. poor ventricular function, redo surgery) or needing combined surgery (e.g. AVR plus coronary artery bypass grafting). Furthermore, the sutureless valves also facilitates the performance of AVR via minimally invasive surgical approaches with small incisions (‘key-hole’ surgery) that result in quicker recovery and return to normal activity as well as desired cosmetic benefits. Another advantage of the new valves is the excellent hemodynamic performance as there is no sewing ring thus reducing the resistance across the prosthetic valves. This feature makes the sutureless valve an excellent choice for patients with small aortic annulus/roots. As the gradient across the valve is minimal, this is expected to lead to better recovery of the sick or hypertrophied left ventricle. As performance is excellent, the durability may also be superior compared to current generation tissue valves.

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IJN EXPERIENCE AND TRACK RECORD

IJN was the first centre in Asia to introduced Sutureless AVR in May 2102. Since then, 26 patients have benefited from this procedure. The sutureless valve is indicated for patients 65 years and above who required AVR with a tissue valve especially for those of medium-to-high perioperative risk, concomitant cardiac surgery, small aortic root and for minimally invasive surgical approaches.

THE DCOTOR WHO PERFORM THE PROCEDURE

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Chief cardiothoracic surgeon Datuk Dr. Mohd Azhari Yakub (left) and clinical director of adult surgery Dr. Jeswant Dillon showing the new sutureless aortic valve prosthesis at the National Heart Institute in Kuala Lumpur.

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