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The Journal of Cardiovascular Surgery 2021 May 20

DOI: 10.23736/S0021-9509.21.11608-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Perceval S valve empire: healing the Achilles’ heel of sutureless aortic valves

Nikolaos A. PAPAKONSTANTINOU 1 , Nikolaos G. BAIKOUSSIS 2, Panagiotis DEDEILIAS 3

1 3rd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Kallithea, Athens, Greece; 2 Cardiac Surgery Department, General Hospital of Athens Ippokrateio, Athens, Greece; 3 Cardiothoracic Surgery Department, General Hospital of Athens Evangelismos’, Athens, Greece


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Aortic valve replacement is the treatment of choice concerning aortic valve disease. Excellent short- and longterm clinical results are reported. Patients referred for aortic valve replacement are getting older and older, so bioprosthetic valves play a more central role worldwide. However, patient comorbidities are also increased more often rendering patients unsuitable for open conventional aortic valve replacement. As a result, transcatheter aortic valve implantation has become the treatment of choice in patients at very high surgical risk. However, the percutaneous technique is related to major disadvantages provided that the diseased native valve is left in place. Its durability is also uncertain. More recently, sutureless Perceval S valve bioprosthesis has gained ground in the field of aortic stenosis therapy filling the gap between conventional aortic valve replacement and transcatheter approach. Excellent haemodynamic and clinical results are reported. Its deployment is performed under direct view and ischemic and overall operative times are significantly decreased. Five-year follow-up results are also optimal. However, the “Achilles’ heel” of sutureless technology is increased rates of postoperative permanent pacemaker implantation requirement compared to conventional approach. The incidence of this complication varies in literature. Patient-related factors such as preoperative conduction disorders, older age and short membranous septum are predictors of postoperative pacemaker requirement. However, several technical modifications with regard to manufacturer recommendations can be adopted to mitigate this complication. Appropriate annular decalcification, higher guiding sutures placement, reduced balloon pressure and duration and avoiding of oversizing can contribute to prevent from this complication.


KEY WORDS: Aortic valve replacement; Sutureless valves; Permanent pacemaker implantation

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