Introduction
Aortic valve stenosis is the most frequent type of adult valvular heart
disease in industrialized countries (1). Its prevalence increases with
age with up to 9.8% in the 80–89 year cohort (2) (3).
Conventional aortic valve replacement (AVR) through median sternotomy is
the established gold-standard for the treatment of severe and/or
symptomatic disease in patients with low-surgical risk(4). However, the
continuous increase in patients age (5) and comorbidities, the growing
percentage of patients who need concomitant surgical procedures,
combined to the fact that the duration of aortic cross-clamping and
cardiopulmonary bypass (CPB) are independent predictors of survival (6),
(7), have created the need for interventions that minimize operative
times and reduce surgical risk.
Sutureless bioprosthesis has emerged as a viable alternative combining
the best of both worlds. By avoiding sutures, it allows reduced aortic
cross-clamping, CPB and global surgical times, as well as the
possibility of complete excision of the native aortic valve and annular
decalcification, helping prevent paravalvular leaks, which is
particularly useful in patients with severe aortic stenosis and an
intermediate to high operative risk (8,9). Sutureless bioprostheses are
especially beneficial in 1) patients who are more sensitive to ischemia;
2) in technically difficult procedures (such as small and/or highly
calcified aortic roots, reoperations and in patients who require
concomitant procedures) (10); 3) in patients with a high risk of
patient-prosthesis mismatch (PPM); and 4) in patients who require faster
recovery. Furthermore, by avoiding stitching through the annulus and
suture knotting, the risk of tearing the aortic annulus and wall or
embolizing foreign material is reduced (11). However, these advantages
must be weighed against the apparent increased risk of PPI (Permanent
Pacemaker Implantation) when compared to conventional AVR (12).
The Perceval® valve (Sorin Group, Saluggia, Italy) is
currently the only truly sutureless valve available, with extensive
research supporting its excellent hemodynamic performance, safety, and
versatility of use. However, several questions remain unanswered, namely
long-term survival and valve durability, risk of endocarditis, the
impact of the apparent increased need for postoperative PPI and safety
of concomitant valvular procedures (13).
Our study aims to analyze the clinical and hemodynamic performance,
safety and durability of the Perceval valves implanted in patients with
aortic valve disease, both in isolated AVR as well as in patients who
underwent concomitant procedures, over a period of 5 years in a tertiary
single European center.