Sutureless aortic valve replacement with concomitant valvular surgery. 
Sutureless aortic valve replacement (SU-AVR) is an alternative technique to standard aortic valve replacement.  We evaluated our experience with the Perceval SU-AVR with concomitant mitral valve surgery, with or without tricuspid valve surgery, and aimed to discuss the technical considerations.  From January 2013 through June 2016, 30 patients with concomitant severe mitral valve disease, with or without tricuspid valve disease, underwent SU-AVR with the Perceval prosthesis in a single center.  The mean age was 73.0 ± 6.6 years, ranging from 63 to 86 years, and 60% (n = 18) were male.  Mean logistic EuroScore of the study cohort was 9.8 ± 4.6.  Concomitant procedures consisted of mitral valve repair (n = 8, 26.6%), mitral valve replacement (n = 22, 73.3%), tricuspid valve repair (n = 18, 60%), tricuspid valve replacement (n = 2, 6.6%), and cryoablation for atrial fibrillation (n = 21, 70%).  Median prosthesis size was 25 mm (large size).  At 1 year, there were 2 deaths from noncardiac causes.  One patient (3.3%) had third-degree atrioventricular block requiring permanent pacemaker implantation.  Three patients (10%) had intraoperative supra-annular malpositioning of the aortic prosthesis, which was safely removed and reimplanted in all cases.  Mean follow-up was 18 ± 4.5 for months (maximum 3 years).  During the postoperative period, sinus rhythm restoration rate in patients who underwent the cryo-maze procedure was 76.1% (n = 16) at discharge.  There was no structural valve deterioration or migration of the prosthesis at follow-up.  Perceval SU-AVR is a technically feasible and safe procedure in patients with severe aortic stenosis with good results even in the presence of multivalvular disease and atrial fibrillation surgery.