\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{A sutureless valve with sutures.}



\author[1]{Fernando Moraes}%
\author[2]{Leonardo Mulinari }%
\affil[1]{heart institute of pernambuco}%
\affil[2]{University of Miami Miller School of Medicine}%


\vspace{-1em}



  
  \date{May 07, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
The use of sutureless valves in infective endocarditis has been
previously reported. Singh et al have reported a single-center
successful surgical treated pulmonary endocarditis in 2 cases with a
sutureless bioprosthesis.%
\end{abstract}%



\sloppy


A sutureless valve with sutures.

The use of sutureless valves in infective endocarditis has been
previously reported. 11Weymann A, Konertz J, Laule M, et al. Are
Sutureless Aortic Valves Suitable for Severe High-Risk Patients
Suffering from Active Infective Aortic Valve Endocarditis? Med Sci
Monit. 2017;23:2782-2787. 22Piperata A, Kalscheuer G, Metras A, Pernot
M, Albadi W, Taymoor S, Peltan J, Oses P, Barandon L, Bottio T, Gerosa
G, Labrousse L. Rapid-deployment aortic valve replacement in high-risk
patients with severe endocarditis. J Cardiovasc Surg (Torino). 2020
Dec;61(6):769-775. doi: 10.23736/S0021-9509.20.11349-1. Epub 2020 Jun
19. PMID: 32558526. 33Fischlein T, Meuris B, Hakim-Meibodi K, et al. The
sutureless aortic valve at 1 year: A large multicenter cohort study. J
Thorac Cardiovasc Surg 2016;151:1617-26.e4

Singh et al 44Singh N, Peek K, Nand P. Novel use of the Perceval
sutureless bioprosthesis for pulmonary valve replacement in high-risk
endocarditis patients: a case series. J Cardiac Surgery have reported a
single-center successful surgical treatment of 2 cases using a
sutureless bioprosthesis in an infected pulmonary native valve. The
implantation of these types of valves in active endocarditis may still
be considered a relative contraindication. In these operations, the
authors used a similar technique proposed for these implantable devices
on the aortic position. However, some modifications were applied from
the ones recommended by the manufacturer. Perceval valves were designed
for aortic valve replacement in aortic valve stenosis. The traditional
incision is a high transverse one, to avoid catching the stent when
closing the vessel, in this case, the pulmonary artery. The authors used
a longitudinal incision in the pulmonary artery. The use of this
incision may have facilitated the visualization and resection of the
vegetation, cusps, and implantation of the valve. Another point to
discuss is the size of the device. The selected valves were XL. To
properly fit those valves the reduction of annulus size was necessary.
The authors also describe tieing the 3 guiding stitches so we can not
consider it a sutureless valve anymore. Probably this modification was
applied because the surgeon was not so confident to leave it sutureless.
as recommended by the manufacturer. Was the beating heart technique used
in these cases the reason for that? Both patients had a good recovery
and the echocardiograms showed the valves functioning properly.

Despite 2 very challenging cases, the authors offered an excellent
alternative technique with one of the best hemodynamically performing
valves available today. The performance of the Perceval valve is well
established in the aortic position. On the pulmonary position, we will
need to wait for the follow-up to observe the performance of those
valves.

Another interesting aspect is that in case of valve degeneration the use
of a transcatheter valve will be an easy alternative to replace it due
to the easy visualization of the valve stent. There is no doubt that
these cases are innovative and bring a promising alternative to the
group of patients with pulmonary valve disease, not only infective
valves but also congenital pulmonary valve disease.

\selectlanguage{english}
\FloatBarrier
\end{document}

