BACKGROUND: Sutureless aortic valve replacement (SuAVR) is gaining popularity for the treatment of aortic stenosis. The advantages of SuAVR over conventional AVR include shorter operative time and easier deployment during minimally invasive procedures. We sought to establish practice patterns and perceptions regarding SuAVR of cardiac surgeons in Canada.
METHODS AND RESULTS: A surgeon survey was developed by established content experts, including cardiac surgeons, cardiologists and methodologists. The survey was administered electronically. Five clinicians piloted the survey for clarity and length. The questionnaire examined several domains including respondent characteristics, factors influencing the decision to implant a SuAVR, barriers to SuAVR use, and interest in participating in a trial. We received responses from 66 of 79 surgeons surveyed (84% response rate), representing 18 hospitals across Canada. Every surgeon surveyed had performed at least 1 SuAVR implantation. Respondents were in independent practice for median of 15 (8-20) years. As per surgeons routine practice, 54 % performed SuAVRs, and 32% performed SuAVR and TAVR; 14% did not perform SuAVR. When asked which factors guided the decision to perform SuAVR included, 73% indicated “hostile root”, 55% indicated small annular size, 42% chose high STS score, 40% chose older age, 25% selected minimally invasive approach, and 23% selected redo-operation. Factors reported to be against implanting SuAVR were young age (73%), low STS score (40%), and large annular size (30%). Respondents felt that barriers to the use of SuAVR included the cost of the device (33%), risk of permanent pacemaker (27%) and durability (12%). The majority of respondents were interested in participating in a randomized controlled trial comparing SuAVR with TAVI (73%).
CONCLUSION: Surgeons reported being more likely to use a SuAVR in patients with high surgical risk, older age, hostile root, redo-operations, and a small annulus. Cost is the main factor limiting SuAVR use in Canada. The surgical community is interested in trial comparing SuAVR with TAVI. These findings will inform the design of this trial.