Avoiding oversizing in sutureless valves leads to lower transvalvular gradients and less permanent pacemaker implants...

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Biomedical Engineering

Background:

• Aortic valve replacement (AVR) with sutureless prostheses requires precise sizing for optimal results.
• Previous sizing strategies may not fully optimize hemodynamic performance or minimize complications.

Purpose of the Study:

• To evaluate the impact of a modified sizing strategy for the Perceval sutureless aortic valve.
• To assess changes in hemodynamic outcomes and postoperative pacemaker implantation rates.

Main Methods:

• Retrospective analysis of 784 patients undergoing AVR with the Perceval valve (2007-2019).
• Comparison of patients before (OLD group) and after (NEW group) the sizing strategy modification.
• Evaluation of prosthesis size, hemodynamic profile (gradients, effective opening area), and pacemaker implantation rates.

Main Results:

• The NEW cohort received significantly smaller indexed valve sizes (13.1 vs 13.5 mm/m²).
• Lower transvalvular gradients (peak: 24.4 vs 28.4 mmHg; mean: 13.6 vs 15.5 mmHg) and increased effective opening area (1.7 vs 1.5 cm²) were observed in the NEW group.
• Postoperative pacemaker implantation significantly decreased from 11% in the OLD group to 6.1% in the NEW group (P=0.016).

Conclusions:

• Correct sizing of sutureless aortic valves is critical for achieving optimal hemodynamics.
• The modified sizing strategy for the Perceval valve led to improved hemodynamic function and a reduced need for postoperative pacemaker implantation.
• This study underscores the importance of precise prosthesis sizing in sutureless AVR to enhance patient outcomes.