Perceval Sutureless Valve in Failing Freestyle Bioprosthesis: A Series of Four Surgical Valves in Valve Implantations

Objective: Aortic valve replacement with the Medtronic Freestyle bioprosthesis offers good results in terms of hemodynamics; however, sporadic failing of the prosthesis in form of cusp rupture or endocarditis may raise the need for a replacement of the prosthesis. Redo operations on a failing Freestyle bioprosthesis can be lengthy and challenging. TAVI is a good option for older and patients at higher risk, but patients with prosthesis endocarditis and younger patients need open surgery. We hereby describe a series of 4 consecutively operated patients using a Perceval sutureless bioprosthesis.

Patients: Between May 2015 and April 2016, we operated four male patients with failing Freestyle bioprostheses using an open surgical valve in valve technique with a Perceval sutureless bioprosthesis (Sorin Group, Salluggia, Italy). Three patients (age 66, 67 and 70 years) presented with severe aortic insufficiency due to cusp rupture of the Freestyle bioprosthesis -one of them with history of concomitant CABG- and 1 patient (age 80 years) presented with endocarditis isolated to the free cusp edge of the Freestyle bioprosthesis.

Methods: A retrospective analysis of all patients operated with this open surgical valve in valve technique. The Perceval sutureless valve was implanted in the usual way after resection of the Freestyle cusps without any further resection on the Freestyle root.

Results: One operation was elective, two were urgent and one was an emergency operation as the patient was acutely decompensated. Two operations were performed with concomitant CABG and one was done through a ministernotomy (J-shaped, through the 3rd ICS). Freestyle sizes in place were 23, 23, 27 and 29; the Perceval sutureless valves implanted were sized 1xS and 3xL respectively. Mean CPB-time was 90 minutes (ranging from 48 to 145 minutes). Mean Cross clamp time was 47 minutes (ranging from 34 - 63 minutes). There was no in hospital mortality. Mean ICU stay was 3, 5 days (ranging from 1 to 7 days). Mean hospital stay was 12 days (ranging from 6 to 24 days). Mean postoperative gradient was 13.7 mm Hg (ranging from 12 to 18 mm Hg). At midterm follow-up (2.2 cumulative patient years): no mortality, no paravalvular leakage, no endocarditis, no SVD.

Conclusion: Sutureless valve technology facilitates redo operations for failing Freestyle bioprosthesis. Sutureless valve implantation might be a feasible option for isolated cusp endocarditis

No conflict of interest has been declared by the author(s).