Perceval Sutureless Bioprosthesis for Degenerative Aortic Valve Stenosis: Initial Experience With 67 Patients

Authors

  • Dejan M. Lazović Clinic for cardiac surgery Clinical Center of Serbia
  • Mladen J. Kočica Clinic for cardiac surgery Clinical Center of Serbia
  • Filip Vučićević Clinic for cardiac surgery Clinical Center of Serbia
  • Milica Kočica- Karadžić Center for anesthesia Clinical Center of Serbia
  • Miloš Grujić Faculty of Medicine, University of Belgrade, Serbia
  • Duško Terzić Clinic for cardiac surgery Clinical Center of Serbia
  • Aleksandar Đorđević Clinic for cardiac surgery Clinical Center of Serbia
  • Danko Grujić Clinic for cardiac surgery Clinical Center of Serbia
  • Dragan Cvetković Clinic for cardiac surgery Clinical Center of Serbia

DOI:

https://doi.org/10.1532/hsf.4027

Keywords:

aortic valvular stenosis Aortic valve, surgical approach

Abstract

Objective: The objective of this prospective study was to evaluate the characteristics (positive and negative) of Perceval S valve in patients undergoing aortic valve replacement with a biological prosthesis. The study included 67 patients operated on at our institution and a mean follow-up period of 18 months.

Methods: From June 2016 to November 2019, 209 patients underwent aortic valve replacement with a biological prosthesis. Of these, 67 patients were included in the study based on the exclusion and inclusion criteria set before the study began. Their data were recorded during their hospital stay (preoperative, intraoperative, and early and late postoperative time).

Results: Fifty-four patients underwent isolated aortic valve replacement (group I) with a Perceval S prosthesis, and 13 patients had combined aortic valve replacement procedures and CABG procedures (group II). Patients were implanted with the following prosthesis sizes: S (N = 12), M (N = 18), L (N = 28), or XL (N = 9). The Perceval S valve successfully was implanted in 67 (91.8%) patients (in 6 patients, the preoperative transthoracic echocardiographic data did not coincide with intraoperative TEE and surgical measurement of the size of the annulus in the suture). Surgical approaches in patients were medial sternotomy (N = 48), mini sternotomy (N = 15), and thoracotomy through the second intercostal space to the right (N = 4). The mean clamping time of the aorta and CPB length for isolated cases was 54 and 82 minutes, respectively, and 96 and 120 minutes for combined procedures. Four (5.9%) patients died within 30 days.

Conclusion: Early postoperative results showed that the Perceval S valve was safe. Further follow up is required to evaluate the long-term duration of patients with this bioprosthesis.

References

Berretta P, Andreas M, Carrel TP, Solinas M, Teoh K, Fischlein T, et al. 2019. Minimally invasive aortic valve replacement with sutureless and rapid deployment valves: a report from an international registry (sutureless and rapid deployment international registry). Eur J Cardiothorac Surg. 56: 793-799.

Cerillo AG, Amoretti F, Mariani M, et al. 2018. Increased Gradients After Aortic Valve Replacement With the Perceval Valve: The Role of Oversizing. Ann Thorac Surg. 106:121-8.

Concistrè G1, Santarpino G, Pfeiffer S, et al. 2013. Two alternative sutureless strategies for aortic valve replacement: a two-center experience. Innovations (Phila). 8: 253-7.

D'Onofrio A, Messina A, Lorusso R, et al. 2012. Sutureless aortic valve replacement as an alternative treatment for patients belonging to the gray zone between transcatheter aortic valve implantation and conventional surgery: a propensity-matched, multicenter analysis. J Thorac Cardiovasc Surg. 144: 1010-6.

Di Eusanio M, Fortuna D, De Palma R. 2011. Aortic valve replacement: results and predictors of mortality from a contemporary series of 2256 patients. J Thorac Cardiovasc Surg. 141:940–7.

Englberger L, Carrel TP, Doss M, Sadowski J, Bartus K, Eckstein FF, et al. 2014. Clinical performance of a sutureless aortic bioprosthesis: five-year results of the 3f Enable long-term follow-up study. J Thorac Cardiovasc Surg. 148(4):1681-7.

Fischlein T, Folliguet T, Meuris B, Shrestha M, Roselli E, McGlothlin A, et al. 2021. Sutureless versus conventional bioprostheses for aortic valve replacement in severe symptomatic aortic valve stenosis. J Thorac Cardiovasc Surg. Mar;161(3):920-932.

Flameng W, Herregods MC, Hermans H, Van der Mieren G, Vercalsteren M, Poortmans G, et al. 2011. Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes. J Thorac Cardiovasc Surg. 142(6):1453-7.

Folliguet TA, Laborde F, Zannis K, Ghorayeb G, Haverich A, Shrestha M. 2012. Sutureless Perceval aortic valve replacement: results of two European centers. Ann Thorac Surg. 93(5):1483-8.

Gilmanov D, Miceli A, Ferrarini M, Farneti P, Murzi M, Solinas M, et al. 2014. Aortic valve replacement through right anterior minithoracotomy: can sutureless technology improve clinical outcomes? Ann Thorac Surg. 98(5):1585-92.

Glauber M, Di Bacco L, Cuenca J, Di Bartolomeo R, Baghai M, Zakova D, et al. 2019. Minimally Invasive Aortic Valve Replacement with Sutureless Valves: Results From an International Prospective Registry Innovations (Phila). Dec 26:1556984519892585.

Kocher AA, Laufer G, Haverich A, et al. 2013. One-year outcomes of the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the EDWARDS INTUITY Valve System. J Thorac Cardiovasc Surg. 145: 1105.

Laborde F, Fischlein T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, et al. 2016. Clinical and haemodynamic outcomes in 658 patients receiving the Perceval sutureless aortic valve: early results from a prospective European multicentre study (the Cavalier Trial) Cavalier Trial Investigators. Eur J Cardiothorac Surg. Mar;49(3):978-86.

Lorusso R, Folliguet T, Shrestha M, Meuris B, Kappetein A, Roselli E, et al. 2020. Sutureless versus Stented Bioprostheses for Aortic Valve Replacement: The Randomized PERSIST-AVR Study Design Thorac Cardiovasc Surg. Mar;68(2):114-123.

Martens S, Sadowski J, Eckstein FS, Bartus K, Kapelak B, Sievers HH, et al. 2011. Clinical experience with the ATS 3f Enable® Sutureless Bioprosthesis. Eur J Cardiothorac Surg. 40(3):749-55.

Meco M, Montisci A, Miceli A, Panisi P, Donatelli F, Cirri S, et al. 2018. Sutureless Perceval Aortic Valve Versus Conventional Stented Bioprostheses: Meta-Analysis of Postoperative and Midterm Results in Isolated Aortic Valve Replacement. J Am Heart Assoc. Feb 16;7(4).

Miceli A, Gilmanov D, Murzi M, Marchi F, Ferrarini M, Cerillo AG, et al. 2016. Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients. Eur J Cardiothorac Surg. Mar;49(3):960-5.

Nguyen A, Fortin W, Mazine A, Bouchard D, Carrier M, El Hamamsy I, et al. 2015. Sutureless aortic valve replacement in patients who have bicuspid aortic valve.J Thorac Cardiovasc Surg. Oct;150(4):851-7.

Phan K, Tsai Y-C, Niranjan N, Yan TD, Di Eusanio M. 2014. Sutureless aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg.

Santarpino G, Pfeiffer S, Concistrè G, Fischlein T. 2012. A supra-annular malposition of the Perceval S sutureless aortic valve: the ‘χ-movement’ removal technique and subsequent reimplantation. Interact Cardiovasc Thorac Surg. (15):280-1.

Santarpino G, Pfeiffer S, Fischlein T. 2012. Sutureless aortic valve replacement to prevent patient-prosthesis mismatch in the era of valve in valve implantation. J Thorac Cardiovasc Surg. 144(1): 279-80.

Sedaghat A, Al-Rashid F, Sinning JM, Wendt D, Thielmann M, Grube E, et al. 2015. Outcome in TAVI patients with symptomatic aortic stenosis not fulfilling PARTNER study inclusion criteria. Catheter Cardiovasc Interv. Nov 15;86(6):1097-104.

Shrestha M, Folliguet T, Meuris B, Dibie A, Bara C, Herregods MC, et al. 2009. Sutureless Perceval S aortic valve replacement: a multicenter, prospective pilot trial. J Heart Valve Dis. 18:698-702.

Shrestha M, Maeding I, Höffler K, Koigeldiyev N, Marsch G, Siemeni T, et al. 2013. Aortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future? Interact Cardiovasc Thorac Surg. 17(5):778-82.

Sian K, Li S, Selvakumar D, Mejia R. 2017. Early results of the Sorin(R) Perceval S sutureless valve: systematic review and meta-analysis. J Thorac Dis. 9(3):711-724.

Published

2021-12-28

How to Cite

Lazovic, D., Kocica, M., Vucicevic, F., kocica, milica, Grujic, M., Terzic, D., Djordjevic, A., Grujic, D., & Cvetkovic, D. (2021). Perceval Sutureless Bioprosthesis for Degenerative Aortic Valve Stenosis: Initial Experience With 67 Patients. The Heart Surgery Forum, 24(6), E1065-E1069. https://doi.org/10.1532/hsf.4027

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