Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis

Abstract

Objective: To highlight the main target points covered by clinical studies on the Perceval sutureless valve for surgical aortic valve replacement (SAVR) and raise a point of discussion for further expansion of its use when compared with stented bioprostheses (SB) and transcatheter aortic valve replacement (TAVR).Methods: We reviewed clinical trials and retrospective studies published up to date and compared the outcomes in terms of mortality, myocardial infarction (MI) stroke, paravalvular leak (PVL), permanent pacemaker implantation (PPI), bleeding and long-term outcomes.Results: Clinical studies showed that 30-day mortality ranged from 0–4% for Perceval and 2.9–7% for TAVR. The incidence of PVL (Perceval 1.9–19.4 vs. TAVR 9–53.5%), PPI (Perceval 2–11.2 vs. TAVR 4.9–25.5%), stroke (Perceval 0 vs. TAVR 0–2.8%), MI (Perceval 0 vs. TAVR 0–3.5%), were all higher in the TAVR group. Compared to other SB, mortality ranged from 0–6.4% for Perceval and 0–5.9% for SB. The incidence of PVR (Perceval 1–19.4 vs. SB 0–1%), PPI (Perceval 2–10.7 vs. SB 1.8–8.5%), stroke (Perceval 0–3.7 vs. SB 1.8–7.3%) and MI (Perceval 0–7.8 vs. SB 0–4.3%) were comparable among the groups. In patients with a bicuspid aortic valve, mortality rate was (0–4%) and PVL incidence was (0–2.3%). However, there was a high incidence of PPI (0–20%), and stroke (0–8%). Long-term survival ranged between 96.7–98.6%.Conclusions: The Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its implantation speed, the reduced cardiopulmonary bypass time, the reduced aortic cross-clamp time and the shorter intensive care unit and hospital length of stay.

Novel use of the Perceval sutureless bioprosthesis for pulmonary valve replacement in high‐risk endocarditis patients: A case series

“…2 The Perceval valve has comparable mortality and shorter intraoperative CPB times compared to insertion of conventional sutured aortic valves. 2,3 Furthermore, successful implantation of Perceval valves has been reported in cases of aortic valve IE. 4 We, however, report on the first known successful implantations of the Perceval sutureless bioprosthesis in the pulmonary position.…”

“…The Perceval sutureless prosthesis has proven to be a safe alternative to contemporary stented and non‐stented sutured valves when implanted in the aortic position 2 . The Perceval valve has comparable mortality and shorter intraoperative CPB times compared to insertion of conventional sutured aortic valves 2,3 . Furthermore, successful implantation of Perceval valves has been reported in cases of aortic valve IE 4 .…”

Sternal‐sparing aortic valve replacement with sutureless valve in bicuspid valve

“…There are several practical implications when it comes to combining SAVR with RAT and the Perceval sutureless valve in patients with 2‐sinus BAV laterolateral phenotype: The surgical learning curve, the complexity of the procedure, and the recognition of anatomical structures with their morphology should be considered in the preprocedural planning, however, none of these aspects should discourage cardiac surgeons from adopting sternal‐sparing techniques to improve the delivery of care for patients, as also stated by other groups 7–11 …”

“…should be considered in the preprocedural planning, however, none of these aspects should discourage cardiac surgeons from adopting sternal-sparing techniques to improve the delivery of care for patients, as also stated by other groups. [7][8][9][10][11] 2. The advantages of SAVR with RAT approach can be followed by early ambulation and superior chest wall stability.…”

Pearls, pitfalls, and surgical indications of the Intuity TM heart valve: A rapid deployment bioprosthesis. A systematic review of the literature

“…In addition, clinical studies have shown the noninferiority of the valves compared to the TAVR both in primary and redo aortic valve surgery. 5 Important characteristics of the rapid deployment valve include improved hemodynamics, a self-expanding radial force, usage in hostile roots, enhanced surgical and recovery speed, and enabling (MINV) cardiac surgery procedures. 6 However, many points deserve to be highlighted including the impact of paravalvular leak (PVL), stroke, permanent pacemaker implantation (PPI), structural valve deterioration (SVD), myocardial infarction (MI), endocarditis, long-term outcomes, MINV approach, hospital costs, and echocardiographic outcomes.…”