Bethesda resident Stephen Miller used to enjoy running half-marathons and 10Ks, but over time, he found his motivation slipping away. He just felt sluggish, he says.

“He had shortness of breath, and he noticed that it was hard for him to do things that he used to do without thinking about it,” says Johns Hopkins cardiothoracic surgeon Reed Quinn.

Stephen, now 60, had been diagnosed with mild aortic stenosis in 2017, and his cardiologist was monitoring it during regular visits. By 2023, the stenosis had grown severe enough for cardiologist Edward Bodurian, who practices at Suburban and Sibley Memorial hospitals, to recommend a valve replacement. 

“He said I wouldn’t make it to 70,” Stephen says of his cardiologist. “It wasn’t super urgent, but I needed to do it.”

Sutureless Valve Means Shorter Surgical and Recovery Time

On Nov. 1, 2023, Quinn, a cardiac surgeon at Suburban Hospital, gave Stephen a new valve in place of his narrow and failing one.

The device, implanted without sutures, consists of a bovine (cow tissue) valve, which is fitted with a nickel titanium alloy stent that expands to hold it in position.

Because no stitches are needed, implanting the device takes about 20 minutes, he says, compared to about an hour for other valves that are held in place with 18 to 24 sutures. 

This means patients spend less time on the heart-lung bypass machine and generally have a shorter recovery, says Quinn. This time saving is particularly important when other procedures, such as coronary artery bypass or mitral valve repair, are required, he says.

In addition, the lack of sutures means there is added artery width for blood flow, Quinn says, as well as opportunity for a valve-in-valve transcatheter aortic valve replacement (TAVR), should the original wear down.

The sutureless valve that Quinn used was approved by the Food and Drug Administration in January 2016. In 2023, Quinn brought expertise with the sutureless valve to Hopkins and trains other surgeons on how to implant the device.

The valve can be installed through a small incision in either the sternum or between the ribs, says Quinn. Stephen’s procedure involved incisions in his sternum while he was on a heart and lung machine.

Quinn used three guiding sutures to position the device, and then a balloon and warm saline to seal it in place.

Pros and Cons of Various Valves

As with all of his patients, Quinn discussed the pros and cons of various valves with Stephen. He noted that mechanical valves don’t wear down, but the recipient must take anticoagulants for life. Biologic valves, from humans, cows or pigs, don’t require such medication, but may need to be replaced in 12 to 20 years.

As Stephen recovered at Suburban Hospital, his care team had him using a walker to move up and down the halls as soon as he was able. He was discharged after three days, and he then used the hospital’s on-site cardiac rehabilitation gym.

Contacted in early February 2024, Stephen said he was starting to feel strong again and was back to exercising.