BACKGROUND: The treatment of aortic valve disease in small annuli remains a debated topic in terms of prosthetic choice - biological or mechanical - and risk of patient prosthesis mismatch. METHODS: The clinical data of the 241 patients who received a small size sutureless prosthesis from the Sorin Universal REgistry on Aortic Valve Replacement (SURE-AVR) (NCT02679404) were analysed at 30 days and at follow-up. The mean age was 75.5 ± 7.8 years (89.2% female); the mean Society of Thoracic Surgeons (STS) score was 4.2 ± 3.2%, and the preoperative NYHA class II or III score was 83.8%. A minimally invasive approach was performed in 52.7% of patients; concomitant procedures were performed in 27.8% of patients. Similar aortic clamping and cardiopulmonary bypass times were observed in the overall isolated cohort and the isolated minimally invasive cohort. The mean intensive care unit (ICU) stay was 2.4 ± 2.0 days and the total length of stay was 10.3 ± 6.1 days. RESULTS: Three deaths were recorded at 30 days (1.2%), 2 for noncardiac causes. One patient experienced a myocardial infarction (0.4%) and 2 a nondisabling stroke (0.8%). 2 patients showed intraprosthetic leakage ≥ 2 and one patient para-prosthetic leakage ≥ 2; of these, one patient required reoperation with prosthesis removal. 4.1% of patients required a pacemaker implant. At a maximum follow-up of 8.1 years, 10 cardiovascular deaths, 4 valve related reinterventions (3 structural valve deterioration (SVD) requiring TAVI Valve-in-Valve, 1 endocarditis) occurred. CONCLUSIONS: With their good clinical outcomes, sutureless prostheses represent a good alternative for patients with small annuli, who are at high risk for annular enlargement and anticoagulant therapy. TRIAL REGISTRATION: Study number 587/2015.

AOU Città della Salute e della Scienza di Torino Ospedale Molinette Torino Italy

Az Ospedaliero Universitaria Ospedali Riuniti di Trieste Trieste Italy

Azienda Ospedaliera dei Colli Ospedale Monaldi Naples Italy

Azienda U L S S n 9 Ospedale di Treviso Ca' Foncello Treviso Italy

Blackpool Teaching Hospitals NHS Foundation Trust Blackpool UK

Cardiothoracic Surgery Department Heart and Vascular Centre Maastricht University Medical Centre Cardiovascular Research Institute Maastricht Maastricht The Netherlands

Centre Hospitalier Régional de Namur Namur Belgium

Centre of Cardiovascular Surgery and Transplantations Brno střed Czech Republic

Chu Poitiers Poitiers France

Clinique Saint Augustin Bordeaux France

Complejo Hospitalario Universitario de A Coruña A Coruña Spain

Department of Cardiac Surgery Città di Lecce Hospital GVM Care and Research Lecce Italy

Department of Clinical and Experimental Medicine Magna Graecia University Catanzaro Italy

Duke University Durham USA

Fondazione Poliambulanza Brescia Brescia Italy

Heart Hospital Pasquinucci Hospital of Massa Massa Toscana Italy

Hospital Clínico San Carlos Madrid Spain

Hospital Reina Sofía de Córdoba Córdoba Spain

King's College Hospital London UK

Kingston General Health Research Institute Ontario Canada

LandesKrankenha us Salzburg Salzburg Austria

Oschner Clinic Foundation New Orleans USA

Ospedale San Bortolo Vicenza Italy

Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona Salerno Italy

Paracelsus Medical University Nuremberg Germany

Policlinico Sant'Orsola Malpighi Bologna Italy

Royal Brompton Hospital London UK

Sant'Ambrogio Clinic Milano Lombardia Italy

Santa Maria Hospital Lisbon Portugal

St Joseph's Regional Medical Paterson USA

St Vincent Heart Center of Indiana Indianapolis USA

The Royal Melbourne Hospital Parkville Australia

UCL Saint Luc Brussels Belgium

Unit of Cardiac Surgery Policlinic Giaccone University of Palermo Palermo Italy

Universitätsklinikum Magdeburg Magdeburg Germany

University Medical Center Groningen Groningen The Netherlands

Valley Health System Ridgewood USA

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