Aortic Valve Replacement With Perceval® Bioprosthesis: Initial Single-Center Experience

Aortic valve replacement (AVR) is the gold standard for the treatment of severe or symptomatic aortic valve stenosis. Less invasive procedures have been developed as an alternative to the conventional technique of full sternotomy approach with stented prosthesis. The Perceval® aortic valve (LivaNova, Milan, Italy) is a sutureless bioprosthesis, of which several reports have shown promising results in terms of mortality, morbidity and hemodynamic performance, especially with a less invasive approach.

Between March 2016 and September 2017, 43 patients underwent AVR with Perceval® bioprosthesis. The mean age was 74.3±6.8 years, 24 (55.8%) patients were female, and the mean EuroSCORE II was 4.1±0.6. Concomitant procedures were CABG (n=11; 25.6%), mitral valve surgery (n=2; 4.7%) and tricuspid valve surgery (n=1; 2.4%).

Isolated AVR were performed in 31 patients (72%), with a less invasive approach in 29 cases (67%), of which 20 patients with upper ministernotomy and 9 patients with right anterior mini-thoracotomy. Cardiopulmonary bypass and cross- clamp times were 69.8±26.6 and 49.2±18.1 minutes for isolated AVR and 106.1±32.6 and 82.9±24.9 minutes for combined procedures, respectively. Preoperative peak and mean gradients were 81.6±24.8 and 49.7±16.1 mmHg, decreasing to 22.4±10.2 and 11.9±5.8 mmHg, respectively, during follow up (mean 9.1±6.0 months). The mean effective orifice area improved from 0.77±0.18 to 1.83±0.45 cm2, and mean left ventricular ejection fraction from 55.0±10.0 to 55.2±8.4%; mean left ventricular mass decreased from 221.6±55.7 to 180.2±42.4 g/m2. Trivial paravalvular leakage occurred in 2 patients, without clinical relevance. Five patients (11.6%) needed pacemaker implantation because complete heart-block before discharge (in 4 patients postdilation modelling wasn't performed). In-hospital mortality was 9.3% (n=4), all non-valve related (mean EuroSCORE II of 9.15±4.0).

AVR with the Perceval bioprosthesis is associated with low mortality rates and excellent hemodynamic performance. Sutureless technology may reduce operative times, especially in combined procedures, making minimally invasive AVR more easily reproducible.