Perceval sutureless valve in freestyle root: new surgical valve-in-valve therapy

Aortic root replacement with biological conduit (homograft, autograft, or xenograft) is a valuable tool, but biological valves are often prone to degeneration. Reoperations usually require root removal and repetition of the Bentall procedure to maintain the same orifice area. A less radical option is to limit replacement to the valve. In cases of calcified or very small roots, standard valve implantation cannot be performed, and bailout with a sutureless valve may be a particularly useful option. Here we have described a case of leaflet rupture in a calcified small Freestyle root (Medtronic Inc, Minneapolis, MN) in which we performed a valve-in-valve (V-in-V) procedure with a Perceval-S prosthesis (Sorin Group, Saluggia, Italy).