The Perceval Sutureless Aortic Valve

Abstract

<jats:p> Surgical aortic valve replacement with a stented prosthesis has been the standard of care procedure for aortic stenosis. The Perceval (LivaNova, London, United Kingdom) is a sutureless aortic valve bioprosthesis currently implanted in more than 20,000 patients. The purpose of this article was to review the literature available after 9 years of clinical experience of the Perceval aortic valve. PubMED, Embase, and the Cochrane Library databases were searched. A meta-analysis of summary statistics from individual studies was conducted. A total of 333 studies were identified and 84 studies were included. Thirty-day mortality and 5-year survival ranged from 0% to 4.9% and 71.3% to 85.5%, respectively. Compared with stented prosthesis, pooled analysis demonstrated a statistically significant reduction in aortic cross-clamp and cardiopulmonary bypass times (minutes) with Perceval (38.6 vs 63.3 and 61.4 vs 84.9, P &lt; 0.00001, respectively). Compared with transcatheter aortic valve implantation, pooled analysis demonstrated a statistically significant reduction with Perceval in paravalvular leakage (1.26% vs 14.31%) and early mortality (2.3% vs 6.9%). Favorable hemodynamics, acceptable valve durability, and ease of implantation in minimally invasive cases were reported as benefits. A trend toward increased rates of permanent pacemaker implantation and low postoperative platelet count were identified. Special use and off-label procedures described included bicuspid aortic valves, valve-in-valve for homo-graft and stentless prosthesis failure, concomitant valvular procedures, porcelain aorta, and endocarditis. The Perceval valve has shown safe clinical and hemodynamic outcomes. Outcomes support its continued usage and potential expansion. </jats:p>

Outcomes of sutureless aortic valve replacement versus conventional aortic valve replacement and transcatheter aortic valve replacement, updated systematic review, and meta‐analysis

“…Our meta‐analysis suggests SuAVR has similar mortality to SAVR, with improved AXC time and CPB time. This reaffirms conclusions of previous reviews suggesting SuAVR may be a safe alternative to SAVR 8,84,85,90 . This conclusion should be taken with caution, as our meta‐analysis also shows significant increase in permanent pacemaker implantation with SuAVR.…”

“…Similar approaches were used to reduce pacemaker implantation rate in TAVR 93 . AXC and CPB time was shorter with SuAVR compared to SAVR, aligning with the results of past studies 8,90 . Reduced AXC and CPB time can be advantageous in several situations: (1) SuAVR would decrease overall operative time with comparable outcomes to SAVR as demonstrated by Dalen et al and Glauber et al, 20,46 (2) redo operations or operations with concomitant procedures as reported by Santarpino et al, 92 and (3) patients at risk of AKI; several studies have linked the duration of AXC and CPB to postoperative AKI 94 …”

Rapid Deployment Valves Are Advantageous in the Redo Setting: A Single-Centre Retrospective Study

“…Research to date has demonstrated that rapid deployment valves (RDVs) are associated with reduced operative times but higher rates of permanent pacemaker insertion. [1][2][3][4][5][6] Overall, despite the reduction in cardiopulmonary bypass (CPB) times, clinical outcomes such as mortality and major morbidity do not differ. [1][2][3][4][5][6] The question remains where do RDVs fit in the management of patients with aortic valve disease?…”

“…[1][2][3][4][5][6] Overall, despite the reduction in cardiopulmonary bypass (CPB) times, clinical outcomes such as mortality and major morbidity do not differ. [1][2][3][4][5][6] The question remains where do RDVs fit in the management of patients with aortic valve disease? Previous research has suggested benefit in minimally invasive cases, in patients with a calcified, small aortic root, and in the redo setting.…”

Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

“…From the available literature, it appears evident that the initial expectations in terms of the consistent reduction of aortic cross-clamp and total cardiopulmonary bypass (CPB) times have been fully met [ 4 , 5 ]. Moreover, it has also been demonstrated that both SBs and RDBs also provide definite advantages in terms of hemodynamic performance, with a significant reduction in the incidences of severe patient–prosthesis mismatch [ 6 ].…”