Medical Student University Of Toronto Grande Prairie, Alberta, Canada
Background: Sutureless valve technology reduces cardiopulmonary bypass and cross-clamp times, facilitating minimally invasive aortic valve replacement (AVR). Although the sutureless Perceval aortic valve prosthesis has shown favorable outcomes in smaller series, large single-center cohorts are limited. We present a 10-year single-center experience of the Perceval valve, including subgroup analyses of isolated AVR, AVR with coronary artery bypass grafting (CABG), and AVR with other combined procedures, focusing on safety, clinical outcomes, and hemodynamic performance.
METHODS AND RESULTS: A retrospective analysis was performed on 309 patients who received the Perceval valve between January 2014 and June 2024. Baseline characteristics, operative details, and postoperative outcomes were recorded. Postoperative outcomes included intensive care unit (ICU) and hospital length of stay, in-hospital mortality, stroke or transient ischemic attack (TIA), myocardial infarction, permanent pacemaker implantation, and echocardiographic metrics. Continuous variables are expressed as mean ± SD or median (interquartile range), categorical variables as n (%); group differences were tested with ANOVA or χ², p < 0.05.
Among 309 patients (mean age 71.6 ± 8.3 years; female 32.7%), surgery was elective in 61.2 % and urgent in 38.8 %. Severe aortic stenosis and bicuspid morphology were present in 81.3 % and 26.3 %, respectively. Isolated AVR was performed in 22%, AVR with CABG in 54.7%, and AVR with other procedures in 23.3%. Most procedures (97.7%) were performed via full sternotomy. The overall cross-clamp time was 61.7 ± 25.9 minutes, ranging from 42.8 ± 15.4 (isolated AVR) to 72.4 ± 22.6 minutes (AVR with CABG) (p < 0.001). Median ICU and hospital stays were 1 (1–2) and 7 (5–10) days, respectively. In-hospital mortality was 4.2% overall (isolated AVR, 1.5%; AVR with CABG, 5.9%; AVR with other, 2.8%). Stroke/TIA occurred in 3.9%, myocardial infarction in 2.6%, and new pacemaker implantation in 6.9%, without significant subgroup differences. Postoperative echocardiography demonstrated a mean aortic gradient of 13.4 ± 5.2 mmHg and an indexed effective orifice area (iEOA) of 0.9 ± 0.3 cm²/m². Patient-prosthesis mismatch (iEOA < 0.65 cm²/m²) occurred in 19.9% of cases. The prosthesis was well-seated in 98.7% of patients; clinically significant paravalvular leak was observed in 1.0%, and trace or mild leaks in 11.7%, without significant subgroup differences.
Conclusion: This decade‑long single‑centre cohort confirms the Perceval sutureless valve’s excellent safety, favourable hemodynamics, and low rates of paravalvular leak and patient-prosthesis mismatch. Its ability to shorten cross‑clamp times—particularly during combined procedures—supports its use in complex and high‑risk surgical populations.
