Introduction: Sutureless aortic prostheses provide an attractive opportunity for high-risk patients with difficult surgical anatomy of the aortic root. Aim of the study: To assess the outcomes of emergent aortic valve replacement (AVR) with Perceval sutureless bioprostheses in a group of high-risk patients in whom their implantation had not been considered before surgery.

Material and methods: Since 2018, 53 sutureless aortic bioprostheses have been implanted in our center. In this single-center retrospective study, 7 high-risk (median EuroSCORE II 9.43%) patients (4 women and 3 men; median age 63 [28 to 73] years) were identified to undergo emergent procedures. They were operated on for active endocarditis on the native valves with extensive destruction of the annulus (n = 4), endocarditis on a previously implanted bioprosthesis (n = 1), organizing thrombus of the mechanical valve (n = 1), and diffuse aortitis (n = 1). Implantation feasibility, as well as postprocedural mortality and morbidity, were evaluated.

Results: The following sizes of bioprostheses were used: XL (n = 3); L (n = 2); M (n = 1), and S (n = 1). The median (minimum; maximum) cross-clamping aortic time was 64 (37; 73) minutes while cardiopulmonary bypass time was 86 (49; 188) minutes, respectively. All patients survived operations and the first 30 days. Two of them died in the hospital because of multiorgan failure on 35th and 45th postoperative days. The follow-up period ranging from 6 to 40 months was completed by all who were discharged alive.

Conclusions: Despite the well-known advantages of sutureless valves, they can be also used successfully in patients in whom standard prosthesis implantation is either impossible or highly demanding, including emergency cases with unexpected intraoperative findings.