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Updated: Mar 29, 2026

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

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Published on: May 21, 2017

Transcatheter Versus Sutureless Aortic Valve Replacement: A Propensity-Matched Single-Center Cohort Study.

Nikoleta Stanitsa¹, Emmanouel Tempelis¹, Ilias Samiotis¹

¹Cardiac Surgery Department, Evangelismos General Hospital, 106 76 Athens, Greece.

Medicina (Kaunas, Lithuania)

|March 28, 2026

Summary

The Perceval sutureless valve demonstrated better long-term survival than transcatheter aortic valve replacement (TAVI) in matched patients. TAVI had more paravalvular leaks, linked to poorer outcomes, highlighting personalized patient selection for aortic valve replacement.

Keywords:

Perceval aortic valve replacement sutureless valve transcatheter aortic valve implantation

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Area of Science:

Cardiology
Cardiovascular Surgery
Medical Devices

Background:

Transcatheter aortic valve replacement (TAVI) is now standard for all risk groups.
The Perceval sutureless valve excels in minimally invasive surgery.
Long-term data and patient selection criteria for both TAVI and Perceval remain limited.

Purpose of the Study:

To compare outcomes of isolated aortic valve replacement (AVR) using the Perceval sutureless valve versus TAVI.
To evaluate long-term safety and efficacy of these two AVR methods.
To identify factors influencing patient selection for Perceval or TAVI.

Main Methods:

Retrospective analysis of 1006 patients undergoing isolated AVR (April 2013-December 2024).
Propensity score matching created 197 pairs comparing TAVI (424) and Perceval (582).
Primary endpoints: all-cause and cardiovascular mortality. Secondary endpoints: acute kidney injury, pacemaker implantation, stroke, effusion, and length of stay.

Main Results:

Perceval showed significantly lower paravalvular leak rates (2.5% vs. 23.4%) and less aortic regurgitation at 6-12 months.
TAVI had higher mean transvalvular gradients, especially in smaller valve sizes.
Perceval implantation resulted in shorter ICU and hospital stays, but TAVI had numerically higher pacemaker implantation rates (11.2% vs. 5.6%).
One-year mortality was higher after TAVI (16.2% vs. 9.1%), with Perceval demonstrating superior overall survival (p < 0.001).

Conclusions:

Perceval sutureless valve implantation was associated with better long-term overall survival compared to TAVI in propensity-matched patients.
Higher rates of paravalvular leaks after TAVI correlated with poorer survival outcomes.
Personalized treatment strategies, guided by a multidisciplinary heart team, are crucial for optimizing aortic valve replacement outcomes.