Perceval S sutureless AVR compared to sutured bioprosthesis aortic valve replacement in patients with small aortic annulus

BACKGROUND:

Aortic valve replacement (AVR) is the surgical preferred choice for aortic stenosis. Particularly sutured aortic valves are more commonly used. In the past years, high risk patients and patients with small aortic valve annulus are undergoing AVR with the sutureless prosthesis. This is expected to reduce morbidity associated with longer bypass time and to decrease risk for prosthesis-patient mismatch due to small aortic annulus.

We reviewed our experience with AVR for patients with small aortic annulus that underwent implantation of Perceval size Small prosthesis compared to sutured 19mm bioprosthesis.

METHODS:

Between 2004-2018, 206 patients with small calcified aortic annulus underwent AVR with either a 19mm bioprosthesis (164 patients) or a Perceval S valve (42 patients). The Mean age was 73±12 in the sutured group versus 71±11 in the Perceval S group (p=0.617).

All patients were prospectively followed and late clinical and echocardiographic outcomes were compared.

RESULTS:

Hospital mortality was 10(6%) in the sutured group versus 2(5%) in the Perceval S group (p=1.000). Bypass and cross clamp time were 118±59 and 92±85 minutes respectively In the sutured group versus 95±54 and 62±40 minutes respectively in the Perceval S group (p=0.032 and p=0.040 respectively). Mean gradient was 21±10 in the sutured aortic valve replacement group versus 15±7 in the sutureless Perceval S group (p=0.003). At a mean follow-up of 67±49 months, survival was 64% in the sutured aortic valve replacement group versus 72% in the sutureless Perceval S group (p=0.405). Late freedom from AR mod + was 97% in the sutured group versus 89% in the Perceval S group (p=0.118).

CONCLUSIONS:

Sutureless Perceval S aortic valve replacement for small aortic annulus is safe and provides shorter operation times and may reduce the risk of patient prosthesis mismatch.