Supra-Annular Perceval Bentall: From Concept to Patient

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Prosthetic Valve Technology

Background:

• Aortic root replacement often involves complex procedures.
• Patient-prosthetic mismatch can occur with traditional aortic valve and graft sizing.
• Sutureless valves offer potential advantages in implantation.

Purpose of the Study:

• To demonstrate a novel supra-annular implantation technique for a composite valve-graft (CVG) for aortic root replacement.
• To describe the anatomic rationale, preclinical validation, and clinical outcomes of this technique.
• To evaluate the feasibility of using a sutureless aortic valve within a Dacron graft.

Main Methods:

• Ex vivo implantation of a Perceval Plus XL valve within a Valsalva Dacron graft to determine optimal sizing.
• In vitro hydrodynamic testing using a pulse duplicator system to validate CVG integrity.
• Supra-annular implantation of the constructed CVG in a clinical setting for aortic root replacement.

Main Results:

• A Perceval XL valve in a 28 mm Valsalva Dacron graft achieved 8% oversize at the inflow ring.
• In vitro testing confirmed valve stability within the graft under physiologic conditions.
• The first SUpra-annular PERceval Bentall (SUPERB) procedure was successfully performed in a patient with aortic stenosis and aneurysm.

Conclusions:

• The SUPERB technique utilizes a Perceval XL valve within a Dacron graft for aortic root replacement.
• Supra-annular positioning decouples valve sizing from native annular dimensions, simplifying the process.
• This approach has the potential to mitigate patient-prosthetic mismatch in aortic root replacement procedures.