Outcome of a Modified Perceval Implantation Technique
Background In our institution, we developed a modification of the standard implantation technique of the Perceval sutureless aortic prosthesis (LivaNova, London, United Kingdom) that involves the usage of snuggers for the guiding sutures during valve deployment. The technique has been described elsewhere. In this article, we present the results of our initial case series comprising 128 consecutive patients.
Methods From September 2016 to June 2018, 128 patients received a sutureless Perceval prosthesis (mean age 72.2 ± 8.5 years, 66 males). The data of the patients were prospectively collected in our general database and retrospectively analyzed using the SPSS software version 25 (IBM SPSS Inc., Chicago, Illinois, United States). Primary end points were primary implantation success and 30-day mortality. All patients underwent transthoracic echocardiography on discharge.
Results Our cohort consisted of real-world scenario patients with infective endocarditis, bicuspid aortic valves and one patient with left ventricular assist device. However, we had 100% primary implantation success with no need for valve explantation or paravalvular leaks. All-cause 30-day mortality was 2.3% (3 patients) with no cardiac deaths. Two patients (1.6%) had a permanent neurological deficit, three patients (2.3%) had new-onset renal dialysis, and four patients (3.1%) needed a permanent pacemaker postoperatively.
Conclusion To our knowledge, this is the first case series to report on a modified implantation technique of the Perceval prosthesis. The Perceval valve prosthesis produces excellent outcome in most pathologies, so that current contraindications should be revised.
* Both authors contributed equally to the study.
Received: 21 November 2018
Accepted: 08 March 2019
19 April 2019 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
- 1 Walther T, Blumenstein J, van Linden A, Kempfert J. Contemporary management of aortic stenosis: surgical aortic valve replacement remains the gold standard. Heart 2012; 98 (Suppl. 04) iv23-iv29
- 2 Généreux P, Head SJ, Hahn R. et al. Paravalvular leak after transcatheter aortic valve replacement: the new Achilles' heel? A comprehensive review of the literature. J Am Coll Cardiol 2013; 61 (11) 1125-1136
- 3 Reardon MJ, Van Mieghem NM, Popma JJ. et al; SURTAVI Investigators. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017; 376 (14) 1321-1331
- 4 Folliguet TA, Laborde F, Zannis K, Ghorayeb G, Haverich A, Shrestha M. Sutureless Perceval aortic valve replacement: results of two European centers. Ann Thorac Surg 2012; 93 (05) 1483-1488
- 5 Stoker T, Mashhour A, Easo J, Kronberg K, Ennker J, Weymann A. Novel treatment of a degenerated bioroot with the use of the sutureless valve technique. Ann Thorac Surg 2018; 105 (05) e213-e214
- 6 Szczechowicz M, Mashhour A, Chaduneli O, Weymann A. Implantation of Perceval valve in mitral position: a new technique. J Thorac Cardiovasc Surg 2018; 1–5 DOI: 10.1016/j.jtcvs.2018.07.057.
- 7 Smith CR. Creative use of a sutureless valve. J Thorac Cardiovasc Surg 2018; 1–3 DOI: 10.1016/j.jtcvs.2018.07.084.
- 8 Mashhour A, Zhigalov K, Szczechowicz M. et al. Snugger method - the Oldenburg modification of Perceval implantation technique. World J Cardiol 2018; 10 (09) 119-122
- 9 Santarpino G, Pfeiffer S, Concistrè G, Fischlein T. A supra-annular malposition of the Perceval S sutureless aortic valve: the ‘χ-movement’ removal technique and subsequent reimplantation. Interact Cardiovasc Thorac Surg 2012; 15 (02) 280-281
- 10 Baran C, Durdu MS, Gumus F. et al. Sutureless aortic valve replacement with concomitant valvular surgery. J Thorac Cardiovasc Surg 2018; 155 (06) 2414-2422
- 11 Shrestha M, Folliguet TA, Pfeiffer S. et al. Aortic valve replacement and concomitant procedures with the Perceval valve: results of European trials. Ann Thorac Surg 2014; 98 (04) 1294-1300
- 12 Gersak B, Fischlein T, Folliguet TA. et al. Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel. Eur J Cardiothorac Surg 2016; 49 (03) 709-718
- 13 Aljalloud A, Shoaib M, Egron S, Arias J, Tewarie L, Schnoering H. The flutter-by effect: a comprehensive study of the fluttering cusps of the Perceval heart valve prosthesis. Interact Cardiovasc Thorac Surg 2018; 27 (05) 664-6740
- 14 Mujtaba SS, Ledingham S, Shah AR, Clark S, Pillay T, Schueler S. Early clinical results of Perceval sutureless aortic valve in 139 patients: freeman experience. Rev Bras Cir Cardiovasc 2018; 33 (01) 8-14
- 15 Falcetta G, Pascarella C, Bertini P, Pratali S, Bortolotti U. Intraoperative displacement of a Perceval sutureless prosthesis. Gen Thorac Cardiovasc Surg 2018; 0 (00) 1-4
- 16 Minh TH, Mazine A, Bouhout I. et al. Expanding the indication for sutureless aortic valve replacement to patients with mitral disease. J Thorac Cardiovasc Surg 2014; 148 (04) 1354-1359
- 17 Fischlein T, Meuris B, Hakim-Meibodi K. et al. The sutureless aortic valve at 1 year: a large multicenter cohort study Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25–29, 2015. J Thorac Cardiovasc Surg 2016; 151 (06) 1617-1626
- 18 Santarpino G, Pfeiffer S, Fischlein T. Sutureless valve implantation in a patient with bicuspid aortic valve. Int J Cardiol 2012; 157 (02) e21-e22
- 19 Nguyen A, Fortin W, Mazine A. et al. Sutureless aortic valve replacement in patients who have bicuspid aortic valve. J Thorac Cardiovasc Surg 2015; 150 (04) 851-857
- 20 Pfeiffer S, Fischlein T, Santarpino G. Sutureless Sorin Perceval aortic valve implantation. Semin Thorac Cardiovasc Surg 2017; 29 (01) 1-7
- 21 Lio A, Miceli A, Solinas M, Glauber M. Initial experience with sutureless Sorin Perceval S aortic prosthesis for the treatment of prosthetic valve endocarditis. Thorac Cardiovasc Surg 2015; 63 (06) 501-503
- 22 Roselló-Díez E, Cuerpo G, Estévez F. et al. Use of the Perceval sutureless valve in active prosthetic aortic valve endocarditis. Ann Thorac Surg 2018; 105 (04) 1168-1174
- 23 Weymann A, Konertz J, Laule M, Stangl K, Dohmen PM. Are sutureless aortic valves suitable for severe high-risk patients suffering from active infective aortic valve endocarditis?. Med Sci Monit 2017; 23: 2782-2787
- 24 Ensminger S, Fujita B, Bauer T. et al; GARY Executive Board. Rapid deployment versus conventional bioprosthetic valve replacement for aortic stenosis. J Am Coll Cardiol 2018; 71 (13) 1417-1428