Ten-year experience with sutureless Perceval bioprosthesis: single-centre analysis in 1157 implants

Abstract

Aims We describe long-term clinical and echocardiographic outcomes in the largest single-centre cohort of patients who underwent aortic valve replacement (AVR) with sutureless Perceval (CorCym, Italy) bioprosthesis. Methods Between March 2011 and March 2021, 1157 patients underwent AVR with Perceval bioprosthesis implantation. Mean age was 77 ± 6 years (range: 46–89 years) and mean EuroSCORE II was 6.7 ± 3.2% (range: 1.7–14.2%). Concomitant procedures were performed in 266 patients (23%). Results Thirty-day mortality was 1.38% (16/1157). Eight hundred and twenty of 891 (92%) isolated AVRs underwent minimally invasive surgery with a ministernotomy (n = 196) or right minithoracotomy (n = 624) approach. Cardiopulmonary bypass and aortic cross-clamp times were 81.1 ± 24.3 and 50.6 ± 11.7 min for isolated AVR and 144.5 ± 34.7 and 96.4 ± 21.6 min for combined procedures. At mean follow-up of 53.08 ± 6.7 months (range: 1–120.5 months), survival was 96.5% and mean transvalvular pressure gradient was 13.7 ± 5.8 mmHg. Left ventricular mass decreased from 152.8 to 116.1 g/m2 (P < 0.001) and moderate paravalvular leakage occurred in three patients without haemolysis not requiring any treatment. Freedom from reoperation was 97.6%. Eight patients required surgical reintervention and 19 patients transcatheter valve-in-valve procedure for structural prosthesis degeneration at a mean of 5.6 years after first operation (range: 2–9 years). Conclusion AVR with a Perceval bioprosthesis is associated with good clinical results and excellent haemodynamic performance in our 10-year experience. Structural degeneration rate of Perceval is comparable with other bioprosthetic aortic valves. Sutureless technology may reduce operative time especially in combined procedures and enable minimally invasive AVR.

Perceval-S over time. Clinical outcomes after ten years of usage

“…After taking under consideration these findings, the adjusted mortality probably related to cardiac event after the postoperative period is decreasing to 35/205 patients, which is satisfactory enough outcome for high-risk patients. In addition to this new evidence show that Perceval-S is associated with satisfactory clinical outcomes and hemodynamic performance, while freedom from re-intervention reaches 97,6% [ 16 ].…”

Sutureless Perceval Valve: Size Matters

“…The Perceval valve can simplify surgical aortic valve replacement by shortening cardiopulmonary bypass and cross-clamp times and providing excellent hemodynamic outcomes. 1,2,4,14,27 Nonetheless, sizing and selection of the appropriate prosthesis remains a challenge that still requires the conversion of several nuanced inputs such as “feel,” tactile feedback, and visual assessment. The incorporation of cardiac CT for more standardized preoperative planning and to complement intraoperative obturator sizing is currently under investigation and is an important area of future study.…”

“…Oversizing also leads to higher rates of permanent pacemaker (PPM) implantation. 8,12–16 Undersizing, on the other hand, may lead to poor leaflet coaptation and a central valvular leak.…”

“…Even when using the small Perceval valve, the resulting transvalvular gradients are as low as single digits, and the hemodynamics are excellent. 1,6–10,14 This is because the low profile of the valve frame is such that when the leaflets open, they are essentially opening to the dimensions of the aortic root.…”

Less Is More? Combined Approaches to Improve Mortality and Morbidity after Aortic Valve Replacement

“…Indeed, in the literature, different authors agree on the fact that, in order to obtain an optimal surgical intervention with a lower 30-day mortality and morbidity, it is mandatory to reduce the ACC times [7][8][9]. At the same time, the availability of sutureless aortic prostheses allowed for the reduction in the length of ACC times, even when using minimally invasive approaches [10][11][12].…”