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Thorac Cardiovasc Surg 2020; 68(07): 602-607
DOI: 10.1055/s-0039-1685512
Original Cardiovascular

Outcome of a Modified Perceval Implantation Technique

Ahmed Mashhour    *
1   Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
,
Konstantin Zhigalov   *
1   Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
,
Sabreen Mkalaluh
1   Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
,
Marcin Szczechowicz
1   Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
,
Jerry Easo
1   Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
,
Harald C. Eichstaedt
1   Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
,
Alexander Weymann
1   Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Abstract

Background In our institution, we developed a modification of the standard implantation technique of the Perceval sutureless aortic prosthesis (LivaNova, London, United Kingdom) that involves the usage of snuggers for the guiding sutures during valve deployment. The technique has been described elsewhere. In this article, we present the results of our initial case series comprising 128 consecutive patients.

Methods From September 2016 to June 2018, 128 patients received a sutureless Perceval prosthesis (mean age 72.2 ± 8.5 years, 66 males). The data of the patients were prospectively collected in our general database and retrospectively analyzed using the SPSS software version 25 (IBM SPSS Inc., Chicago, Illinois, United States). Primary end points were primary implantation success and 30-day mortality. All patients underwent transthoracic echocardiography on discharge.

Results Our cohort consisted of real-world scenario patients with infective endocarditis, bicuspid aortic valves and one patient with left ventricular assist device. However, we had 100% primary implantation success with no need for valve explantation or paravalvular leaks. All-cause 30-day mortality was 2.3% (3 patients) with no cardiac deaths. Two patients (1.6%) had a permanent neurological deficit, three patients (2.3%) had new-onset renal dialysis, and four patients (3.1%) needed a permanent pacemaker postoperatively.

Conclusion To our knowledge, this is the first case series to report on a modified implantation technique of the Perceval prosthesis. The Perceval valve prosthesis produces excellent outcome in most pathologies, so that current contraindications should be revised.

Keywords

cardiac - aortic valve and root - aorta/aortic

* Both authors contributed equally to the study.




Publication History

Received: 21 November 2018

Accepted: 08 March 2019

Article published online:
19 April 2019

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Walther T, Blumenstein J, van Linden A, Kempfert J. Contemporary management of aortic stenosis: surgical aortic valve replacement remains the gold standard. Heart 2012; 98 (Suppl. 04) iv23-iv29
    CrossrefPubMedSearch in Google Scholar
  • 2 Généreux P, Head SJ, Hahn R. et al. Paravalvular leak after transcatheter aortic valve replacement: the new Achilles' heel? A comprehensive review of the literature. J Am Coll Cardiol 2013; 61 (11) 1125-1136
    CrossrefPubMedSearch in Google Scholar
  • 3 Reardon MJ, Van Mieghem NM, Popma JJ. et al; SURTAVI Investigators. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017; 376 (14) 1321-1331
    CrossrefPubMedSearch in Google Scholar
  • 4 Folliguet TA, Laborde F, Zannis K, Ghorayeb G, Haverich A, Shrestha M. Sutureless Perceval aortic valve replacement: results of two European centers. Ann Thorac Surg 2012; 93 (05) 1483-1488
    CrossrefPubMedSearch in Google Scholar
  • 5 Stoker T, Mashhour A, Easo J, Kronberg K, Ennker J, Weymann A. Novel treatment of a degenerated bioroot with the use of the sutureless valve technique. Ann Thorac Surg 2018; 105 (05) e213-e214
    CrossrefPubMedSearch in Google Scholar
  • 6 Szczechowicz M, Mashhour A, Chaduneli O, Weymann A. Implantation of Perceval valve in mitral position: a new technique. J Thorac Cardiovasc Surg 2018; 1–5
    CrossrefPubMedSearch in Google Scholar
  • 7 Smith CR. Creative use of a sutureless valve. J Thorac Cardiovasc Surg 2018; 1–3
    CrossrefPubMedSearch in Google Scholar
  • 8 Mashhour A, Zhigalov K, Szczechowicz M. et al. Snugger method - the Oldenburg modification of Perceval implantation technique. World J Cardiol 2018; 10 (09) 119-122
    CrossrefPubMedSearch in Google Scholar
  • 9 Santarpino G, Pfeiffer S, Concistrè G, Fischlein T. A supra-annular malposition of the Perceval S sutureless aortic valve: the ‘χ-movement’ removal technique and subsequent reimplantation. Interact Cardiovasc Thorac Surg 2012; 15 (02) 280-281
    CrossrefPubMedSearch in Google Scholar
  • 10 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
    CrossrefPubMedSearch in Google Scholar
  • 11 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
    CrossrefPubMedSearch in Google Scholar
  • 12 Gersak B, Fischlein T, Folliguet TA. et al. Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel. Eur J Cardiothorac Surg 2016; 49 (03) 709-718
    CrossrefPubMedSearch in Google Scholar
  • 13 Aljalloud A, Shoaib M, Egron S, Arias J, Tewarie L, Schnoering H. The flutter-by effect: a comprehensive study of the fluttering cusps of the Perceval heart valve prosthesis. Interact Cardiovasc Thorac Surg 2018; 27 (05) 664-6740
    PubMedSearch in Google Scholar
  • 14 Mujtaba SS, Ledingham S, Shah AR, Clark S, Pillay T, Schueler S. Early clinical results of Perceval sutureless aortic valve in 139 patients: freeman experience. Rev Bras Cir Cardiovasc 2018; 33 (01) 8-14
    PubMedSearch in Google Scholar
  • 15 Falcetta G, Pascarella C, Bertini P, Pratali S, Bortolotti U. Intraoperative displacement of a Perceval sutureless prosthesis. Gen Thorac Cardiovasc Surg 2018; 0 (00) 1-4
    PubMedSearch in Google Scholar
  • 16 Minh TH, Mazine A, Bouhout I. et al. Expanding the indication for sutureless aortic valve replacement to patients with mitral disease. J Thorac Cardiovasc Surg 2014; 148 (04) 1354-1359
    CrossrefPubMedSearch in Google Scholar
  • 17 Fischlein T, Meuris B, Hakim-Meibodi K. et al. The sutureless aortic valve at 1 year: a large multicenter cohort study Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25–29, 2015. J Thorac Cardiovasc Surg 2016; 151 (06) 1617-1626
    CrossrefPubMedSearch in Google Scholar
  • 18 Santarpino G, Pfeiffer S, Fischlein T. Sutureless valve implantation in a patient with bicuspid aortic valve. Int J Cardiol 2012; 157 (02) e21-e22
    CrossrefPubMedSearch in Google Scholar
  • 19 Nguyen A, Fortin W, Mazine A. et al. Sutureless aortic valve replacement in patients who have bicuspid aortic valve. J Thorac Cardiovasc Surg 2015; 150 (04) 851-857
    CrossrefPubMedSearch in Google Scholar
  • 20 Pfeiffer S, Fischlein T, Santarpino G. Sutureless Sorin Perceval aortic valve implantation. Semin Thorac Cardiovasc Surg 2017; 29 (01) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 21 Lio A, Miceli A, Solinas M, Glauber M. Initial experience with sutureless Sorin Perceval S aortic prosthesis for the treatment of prosthetic valve endocarditis. Thorac Cardiovasc Surg 2015; 63 (06) 501-503
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Roselló-Díez E, Cuerpo G, Estévez F. et al. Use of the Perceval sutureless valve in active prosthetic aortic valve endocarditis. Ann Thorac Surg 2018; 105 (04) 1168-1174
    CrossrefPubMedSearch in Google Scholar
  • 23 Weymann A, Konertz J, Laule M, Stangl K, Dohmen PM. Are sutureless aortic valves suitable for severe high-risk patients suffering from active infective aortic valve endocarditis?. Med Sci Monit 2017; 23: 2782-2787
    CrossrefPubMedSearch in Google Scholar
  • 24 Ensminger S, Fujita B, Bauer T. et al; GARY Executive Board. Rapid deployment versus conventional bioprosthetic valve replacement for aortic stenosis. J Am Coll Cardiol 2018; 71 (13) 1417-1428
    CrossrefPubMedSearch in Google Scholar