Sutureless versus Catheter-Based Aortic Valve Prosthesis: Hemodynamic Performance and the Effect of Explanting the Native Valve

Objectives: To compare the clinical and in vivo hemodynamic performance a rapid deployment sutureless aortic valve (Sorin Perceval) prosthesis with a transcatheter aortic valve prosthesis (Edwards Sapien III) to reveal the possible hemodynamic effect of native aortic valve explanation.

Methods: From January 2014 until March 2017, all patients who underwent aortic valve replacement in a tertiary institution were scanned for inclusion in this retrospective analysis. The inclusion criteria were patients over 18 years old, undergoing isolated aortic valve surgery with the use of either the Sorin Perceval or the Edwards Sapien III for valve replacement. The exclusion criteria included emergency surgery and endocarditis. No other exclusion criteria applied. The study cohort was classified into two groups according to the used valve prosthesis. In each group, the patients were further classified into two subgroups according to the annular diameter whether it is below 23 mm or not. The preoperative, operative and postoperative data, as well as the transthoracic (TTE) and transesophageal echo (TEE) data were collected and analyzed.

Results: The Perceval group included 95 patients (age: 73.4 ± 6.6 years, 40% males, LVEF: 58.11 ± 9.9, the Sapien group included 98 patient (age: 80.8 ± 4.9 years, 53% males, LVEF: 52.72 ± 12.7). The analysis showed a postoperative significantly larger orifice area in patients with annular diameter below 23 mm (1.5 vs. 1.3 cm², Perceval vs. Sapien, p = 0.003). There were no significant differences in the peak or mean gradients in this subgroup of patients (p = 0.5 and 0.3 respectively). For patients with an annular diameter that equals or greater than 23 mm, there were no significant differences in the hemodynamic measures with p of 0.62, 0.19, and 0.13 for the orifice area, mean and maximum pressure gradients. Sapien group showed a significantly higher rate of paravalvular leaks (AI ≥1: 1.05 vs. 27.07%, Perceval vs. Sapien, p < 0.001). There were no significant difference in the postoperative need for pacemaker (14.7 vs. 13.2%, Perceval vs. Sapien, p = 0.76).

Conclusions: The Sorin Perceval valve might offer a better hemodynamic performance than the Edwards Sapien valve in patients with smaller aortic annulus. The clinical significance of the difference in hemodynamic performance cannot be confirmed or refuted.