In vitro comparison of everting vs . non-everting suture techniques for the implantation of a supra-annular biological heart valve

Aortic valve stenosis is the most frequent valvular disease in western countries mainly caused by degenerative calcification (1). The gold standard for the treatment of such degenerated valves is aortic valve replacement (AVR) (2). In 2017, 9,484 surgical aortic valve replacements with biological valves were performed in Germany at which the hemodynamic outcome of the procedure is determined by different factors (3). In this respect, biological valves with a rigid (stented) sewing rings are known to offer comfortable implantation but a smaller orifice areas than native valves and potentially create turbulent flow patterns (4). Whereas stentless prostheses provide optimal orifice areas due to the lack of surrounding material and are supposed to maintain physiologic aortic root dynamics (5). However, the implantation of this valve type requires an experienced surgeon. New generation stented valves are designed for supra-annular implantation, offering the maximum achievable orifice area by utilizing free space within the aortic root, thus an actual greater valve diameter could be applied to reduce the risk of patient-prosthesis-mismatch