Short-term outcomes of Perceval sutureless valve replacement in patients with type 0 bicuspid aortic valve

The Perceval sutureless aortic valve offers favorable hemodynamics and reduced operative times in surgical aortic valve replacement (AVR). However, its use in patients with type 0 bicuspid aortic valve (BAV), a condition characterized by annular asymmetry and absence of a raphe, remains controversial, and evidence for this specific anatomical subtype remains limited. This study evaluated the short-term outcomes of Perceval valve implantation in patients with type 0 BAV.

This single-center, retrospective cohort study included 11 consecutive patients with type 0 BAV who underwent Perceval sutureless AVR between June 2022 and February 2025. All procedures were performed via median sternotomy by a single experienced surgeon. Perioperative, echocardiographic, and clinical outcomes were obtained from institutional databases. Follow-up was conducted through structured telephone interviews.

All procedures were completed successfully without intraoperative complications. The mean annular diameter was 22.7±1.6 mm, and the mean eccentricity index was 0.2±0.1. Cardiopulmonary bypass and cross-clamp times were 79.6±19.1 and 55.0±16.4 minutes, respectively. No patient experienced paravalvular leakage (PVL), atrioventricular block requiring permanent pacing, valve migration, stroke, or in-hospital mortality. Discharge echocardiography indicated preserved ventricular function and favorable hemodynamics, with a mean gradient of 12.8±1.9 mmHg. Over a median follow-up of 11 months (range, 2-13 months), no valve-related complications, reinterventions, or late deaths occurred.

The findings from this study indicate that the Perceval sutureless valve can be safely and effectively implanted in selected patients with type 0 BAV, including those with a small aortic annulus. With proper preoperative assessment, favorable short-term outcomes can be consistently achieved.