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Updated: May 5, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

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Sutureless Aortic Valve Replacement with Annular Plication Technique in an Oversized Annulus.

Shota Inoue¹, Chikara Ueki¹, Minoru Tabata^1,2

¹Department of Cardiovascular Surgery, Toranomon Hospital, Tokyo105-8470, Japan.

Interdisciplinary Cardiovascular and Thoracic Surgery

|December 1, 2025

Summary

Annular plication successfully reduced aortic annulus size, enabling sutureless Perceval valve implantation in a patient with severe aortic regurgitation. This technique expands minimally invasive options for valve replacement in select patients.

Keywords:

annular plication technique aortic valve minimally invasive cardiac surgery sutureless valve

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Published on: March 26, 2018

Area of Science:

Cardiovascular Surgery
Interventional Cardiology
Medical Device Technology

Background:

Severe aortic regurgitation and moderate aortic stenosis pose significant treatment challenges.
Sutureless valve implantation, like the Perceval valve, offers minimally invasive benefits but has limitations regarding annulus size.
A 72-year-old male presented with symptomatic severe aortic regurgitation and moderate aortic stenosis with a 30 mm annular diameter, exceeding typical Perceval valve sizing.

Purpose of the Study:

To describe the successful application of an annular plication technique to facilitate sutureless valve implantation.
To evaluate the safety and efficacy of annular plication in enabling Perceval valve use in a patient with a mildly oversized aortic annulus.
To demonstrate the feasibility of a totally endoscopic approach for this combined procedure.

Main Methods:

A novel annular plication technique using three horizontal mattress sutures was performed to reduce aortic annulus dimensions.
A sutureless Perceval XL valve was implanted following annular plication.
A totally endoscopic approach via right mini-thoracotomy was utilized for the entire procedure.

Main Results:

Postoperative echocardiography confirmed accurate valve placement and absence of paravalvular leak.
The patient experienced an uneventful recovery and remained asymptomatic at 3-year follow-up.
Excellent prosthesis function was maintained throughout the follow-up period.

Conclusions:

Annular plication is a viable technique to enable sutureless Perceval valve implantation in patients with mildly oversized aortic annuli.
This approach expands the applicability of minimally invasive valve surgery.
The described technique offers a safe and effective solution for complex aortic valve disease management.