The aortic valve is one of four valves in the heart. When the heart beats, this valve must open properly for blood to flow throughout the body.
Aortic stenosis, the severe obstruction of this valve, is very common in elderly patients. It has a poor prognosis with medical treatment, with an approximate mortality of 25% at one year and 50% two years after the onset of symptoms.
In the last 40 years, valvular heart surgery has shown very satisfactory results both in the short and long term, even in very elderly patients. Even so, up to 30% of patients affected by this pathology have never been referred for surgical treatment. In most cases because their physician considers the risk too high for conventional surgery. These patients have very important risk factors, such as renal failure, previous cerebral embolisms or re-interventions, and in addition, they are in a situation of significant “frailty”.
In order to offer the best treatment option, it is very important to perform a complete and individual evaluation of each patient (comorbidity, adaptability, degree of dependency) by a multidisciplinary group (heart-team).
The new treatment with transcatheter heart valves (TAVIs) is an alternative to conventional surgery in high-risk patients. The results have been good, but some relevant issues remain unresolved, such as the increase in neurological complications, the persistence of significant paravalvular leaks, vascular complications and the high cost of these prostheses.
Sutureless valves have appeared as an alternative to conventional valves and transcatheter valves. They allow high-risk patients to be operated safely and with very good results. The process is faster, since less time is spent in surgery, safer (direct vision, resection of the pathological native valve) and with less surgical aggression thanks to the mini-incisions.
Currently there is already a long experience of more than nine years of follow-up with more than 20,000 sutureless aortic prostheses implanted in Europe with excellent results. The group of Dr. Ruyra Baliarda pioneered these new techniques in Spain and has the most experience in the country with more than 300 cases in the last five years.