The Hemodynamic Performance of the Perceval Sutureless Aortic Valve in a Propensity-Matched Comparison to the Carpentier–Edwards Perimount and Perimount Magna Ease Valves for Aortic Valve Replacement

Abstract

Objectives The Perceval valve was shown to facilitate minimal-invasive operations and shorten operative times. We aimed to compare the early results of the Perceval valve to those of well-established valves, namely the Carpentier–Edwards Perimount and Perimount Magna Ease valve protheses, in terms of their clinical and hemodynamic performances.

Methods This is a single-center, retrospective, observational cohort study. For every patient operated with a Perceval valve, the last patient before and the next following patient receiving a Perimount valve was included in a control group leading to a 2:1 ratio (Perimount:Perceval). A propensity score matching was used and a subgroup analysis was performed to compare early and late Perceval patients as the sizing technique was changed over time.

Results From November 2013 to November 2017, 423 patients were identified. These included 141 consecutive patients receiving a Perceval valve through a full- or a hemi-sternotomy. In addition, 282 patients receiving a Perimount or a Magna Ease valve were enrolled. After propensity score matching, 127 matched patients were compared. Operating times were shorter and postoperative transvalvular pressure gradients were lower in the Perceval group (15 vs. 17 mmHg, p = 0.002). There was no difference in mortality and stroke rates. The incidence of new pacemaker implantations was higher in the Perceval group (7.1 vs. 18.9%, p = 0.005), mainly due to a very high incidence in the early phase of our Perceval experience prior to a change in the Perceval implantation technique. Subgroup analysis showed significantly better results in the late Perceval group.

Conclusion Surgical outcome was good in both groups. The Perceval valve exhibited lower postoperative gradients, and the need for pacemaker implantation was higher and can be reduced by avoiding oversizing.

Keywords

sutureless Perceval valve - Perimount valve - aortic valve replacement - mean gradient

Publikationsverlauf

Eingereicht: 25. März 2022

Angenommen: 28. Juni 2022

Artikel online veröffentlicht:
20. August 2022

• References

• 1 Mǎrgulescu AD. Assessment of aortic valve disease - a clinician oriented review. World J Cardiol 2017; 9 (06) 481-495
• 2 Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368 (9540): 1005-1011
• 3 Lindman BR, Clavel MA, Mathieu P. et al. Calcific aortic stenosis. Nat Rev Dis Primers 2016; 2: 16006
• 4 Falk V, Baumgartner H, Bax JJ. et al; ESC Scientific Document Group. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017; 52 (04) 616-664
• 5 Berretta P, Andreas M, Carrel TP. et al. Minimally invasive aortic valve replacement with sutureless and rapid deployment valves: a report from an international registry (Sutureless and Rapid Deployment International Registry)†. Eur J Cardiothorac Surg 2019; 56 (04) 793-799
• 6 Pfeiffer S, Fischlein T, Santarpino G. Sutureless sorin perceval aortic valve implantation. Semin Thorac Cardiovasc Surg 2017; 29 (01) 1-7
• 7 Glauber M, Moten SC, Quaini E. et al. International expert consensus on sutureless and rapid deployment valves in aortic valve replacement using minimally invasive approaches. Innovations (Phila) 2016; 11 (03) 165-173
• 8 Kueri S, Kari FA, Fuentes RA, Sievers HH, Beyersdorf F, Bothe W. The use of biological heart valves. Dtsch Arztebl Int 2019; 116 (25) 423-430
• 9 Bourguignon T, Bouquiaux-Stablo AL, Candolfi P. et al. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Ann Thorac Surg 2015; 99 (03) 831-837
• 10 König KC, Wahlers T, Scherner M, Wippermann J. Sutureless perceval aortic valve in comparison with the stented Carpentier-Edwards Perimount aortic valve. J Heart Valve Dis 2014; 23 (02) 253-258
• 11 Meco M, Montisci A, Miceli A. et al. Sutureless perceval aortic valve versus conventional stented bioprostheses: meta-analysis of postoperative and midterm results in isolated aortic valve replacement. J Am Heart Assoc 2018; 7 (04) e006091
• 12 Forcillo J, Bouchard D, Nguyen A. et al. Perioperative outcomes with sutureless versus stented biological aortic valves in elderly persons. J Thorac Cardiovasc Surg 2016; 151 (06) 1629-1636
• 13 Tasca G, Vismara R, Mangini A. et al. Comparison of the performance of a sutureless bioprosthesis with two pericardial stented valves on small annuli: an in vitro study. Ann Thorac Surg 2017; 103 (01) 139-144
• 14 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
• 15 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
• 16 Shrestha M, Fischlein T, Meuris B. et al. European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patients. Eur J Cardiothorac Surg 2016; 49 (01) 234-241
• 17 Dalén M, Biancari F, Rubino AS. et al. Aortic valve replacement through full sternotomy with a stented bioprosthesis versus minimally invasive sternotomy with a sutureless bioprosthesis. Eur J Cardiothorac Surg 2016; 49 (01) 220-227
• 18 González Barbeito M, Estévez-Cid F, Pardo Martínez P. et al. Surgical technique modifies the postoperative atrioventricular block rate in sutureless prostheses. J Thorac Dis 2019; 11 (07) 2945-2954
• 19 Vogt F, Moscarelli M, Nicoletti A. et al. Sutureless aortic valve and pacemaker rate: from surgical tricks to clinical outcomes. Ann Thorac Surg 2019; 108 (01) 99-105
• 20 Cerillo AG, Amoretti F, Mariani M. et al. Increased gradients after aortic valve replacement with the perceval valve: the role of oversizing. Ann Thorac Surg 2018; 106 (01) 121-128