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.