Use of the Perceval-S Bioprosthesis at an Australian Tertiary Centre

This retrospective analysis study aimed to assess short-term haemodynamic outcomes of the Perceval sutureless valve (LivaNova, London, UK) at an Australian institution.

Patients undergoing sutureless aortic valve replacement (SU-AVR) between 2014 and 2022 at the Alfred Hospital were included. The haemodynamic performance of the SU-AVR was assessed by obtaining echocardiogram reports. Mean aortic effective orifice area (cm²), mean transaortic pressure gradient (mmHg) and left ventricular mass (g) were investigated.

Seventy-three (73) patients underwent SU-AVR. Fifteen (15) patients were lost to follow-up. The mean follow-up was 36.93±23.28 months in 58 patients. Patients were followed up to 72 months. Median follow-up was 36.0 (interquartile range: 39.0) months. Isolated AVR was performed in 29 patients (39.7%) and coronary artery bypass graft+AVR was performed in 31 patients (42.5%). The mean (±standard deviation) cardiopulmonary bypass time was 83.2±36.8 minutes and the mean aortic cross-clamp time was 59.2±32.1 minutes. There was one case of structural valve deterioration causing aortic stenosis and two cases of major paravalvular leak. Five (5) explants were performed (paravalvular leak; n=2, infective endocarditis; n=2, structural valve deterioration; n=1). The preoperative mean gradient was 40.55±18.02 mmHg. At 36 months, the gradients remained low at 11.25±4.74 mmHg. Left ventricular (LV) remodelling occurred as demonstrated by a mean LV mass of 248.34±68.6 g preoperatively and 200.0±47.57 g at 36 months. The mean aortic effective orifice area was 0.948±0.48 cm² preoperatively and 1.86±0.43 cm² at 36 months. Good haemodynamic performance was observed across the 72-month follow-up period. Seven mortalities were recorded, with causes attributed to sepsis (n=1, 1.37%), endocarditis (n=5, 6.85%) and withdrawal of ventricular assist device (n=1, 1.37%). Morbidity included stroke (n=2), renal insufficiency (n=6), pneumonia (n=8) and return to theatre for bleeding (n=5).

The deployment of the Perceval S bioprosthesis valve has excellent haemodynamic performance at a mean of 36 months of follow-up.