Clinical And Hemodynamics Outcomes Of Patients In Combined Surgical Aortic Valve Replacement And Coronary Artery Bypass Grafting With Stented And Sutureless Bioprostheses: A Multicenter Study

OBJECTIVE: Sutureless bioprostheses with self-anchoring systems reduce surgical time and simplify procedures. This multicenter study compares clinical and hemodynamic outcomes of stented (STE) versus sutureless (SUT) bioprostheses in patients undergoing combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). METHODS: Data from patients undergoing combined SAVR+CABG at participating centers were analyzed. Patients were grouped by implanted valve type: STE and SUT groups. Primary endpoints were 30-day mortality and pacemaker implantation rate. Secondary endpoints included cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times, and hemodynamic outcomes. Preoperative variables were defined according to EuroSCORE Il, and postoperative outcomes according to VARC-3 criteria. Statistical analyses included descriptive tests, Wilcoxon for continuous variables,Chi-squared or Fisher's exact tests for categorical variables, and linear regression to identify determinants of postoperative hemodynamic results. RESULTS: The 394 patients included were divided into STE (51.7%) and SUT (48.2%) groups. Device success was comparable in both groups.Thirty-day mortality was 4% in STE and 2.6% in SUT, (p=0.6). Pacemaker implantation rates were 3.5% for STE and 6.3% for SUT (p=0.2).Surgical times were shorter in SUT: median CPB times were 157 minutes for STE and 128 minutes for SUT (p=0.001); ACC times were 117 minutes and 95 minutes respectively (p<0.001). Peak gradients were 19 mmHg for STE versus 15 mmHg for SUT; mean gradients were 10 mmHg and 9 mmHg respectively. Multiple linear regression analysis demonstrated a significant association between sutureless valves and gradients reduction (p<0.001). Furthermore, left ventricular ejection fraction improved: median 57% in SUT vs 54% in STE (p=0.002). CONCLUSIONS: In patients undergoing combined SAVR+ CABG, sutureless bioprostheses guaranteed shorter operative times and improved early hemodynamic benefits compared to stented valves. The clinical significance of these findings requires confirmation through long-term follow-up and future prospective randomized studies.