Perceval prosthesis implantation into challenging degenerated aortic valves: a literature review and case series
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Updated: Sep 12, 2025

Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
Pouya Nezafati1, Chimezi Uchime2, Sumit Yadav3,4
1Department of Cardiothoracic Surgery, Liverpool Hospital, New South Wales Health, Sydney, Australia.
Background:
The Perceval Sutureless prosthesis can increase the effective orifice area (EOA) and reduce the chance of prosthesis-patient mismatch (PPM). This report presents three patients with challenging degenerated bioprosthetic valves undergoing redo aortic valve replacement (rAVR) using the Perceval (LivaNova, London, UK) prosthesis from a cohort of more than 300 performed cases and a review of the literature on the management of challenging degenerated valves.
Methods:
Case 1: Degenerated 23 mm Trifecta with the valve cage densely adherent to the annulus. Cage with sewing ring were excised and annulus sized to a large Perceval valve. Case 2: Degenerated 29 mm Epic from a Bentall's procedure. Calcified and rigid prosthetic leaflets as well as stent posts were excised and XL Perceval implanted. Case 3: Degenerated 27 mm Epic with signs of endocarditis from a history of Bentall's procedure. Three calcified leaflets of the Epic valve were completely excised. The orifice accepted a medium Perceval.
Results:
The total Cardiopulmonary Bypass (CPB) and aortic cross clamp (ACC) times (in minutes) were 99.76, 117.68 and 143.99 in Cases 1, 2 and 3, respectively. Moreover, post-implantation transesophageal echocardiogram (TOE) demonstrated a well-seated valve, no paravalvular leak in all cases and a peak gradient of 12.7 mmHg, 14.8 mmHg and 17.7 mmHg in Cases 1, 2 and 3, respectively.
Conclusion:
The Perceval prosthesis is an excellent choice for rAVR, as it can safely simplify challenging cases at risk of PPM and is an excellent valve-in-valve alternative to degenerated or infected Bentall valves with patent graft. The Perceval prosthesis can be well seated on the different structures of a degenerated bioprosthetic valve.
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