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Implantation Of Perceval Valve On Challenging Degenerated Aortic Valves With Three Approaches
Pouya Nezafati, Sumit Yadav;
townsville university hospital, townsville, Australia
BACKGROUND:Perceval Sutureless Aortic Valve decreases cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) time, and with its special design, it can increase effective orifice area (EOA) and reduced chance of prosthesis-patient mismatch (PPM).
This report presents three patients with challenging degenerated bioprosthetic valves undergoing redo AVR using the Perceval (LivaNova) prosthesis by a single surgeon from a cohort of more than 300 performed cases.
METHODS:Case 1: 70M with a BSA of 1.88 and a failed 23mm Trifecta with the valve cage densely adherent to the annulus which was mobilized in the endarterectomy plane and taken out in the cage first and the stitches as well as swing ring in the second step. The annulus was debrided of calcification and pledgers. Annulus was sized to a large Perceval valve.Case 2: 65M with 156kg on a background of Bentall’s procedure with 29mm Epic and a 32mm Valsalva graft. Degenerated calcified and rigid prosthetic leaflets were excised and valve sized to medium. In order to overcome a highly possible PPM due to BSA, the decision was made to excise the valve stent posts and annulus sized again with this time an XL Perceval implanted. Case 3: A 73M with a BSA of 2.11 with a history of Bentall’s procedure with 27mm Epic and 32mm Valsalva graft with signs of endocarditis. Three calcified leaflets of the Epic valve were completely excised. The orifice accepted a Medium Perceval sizer.
RESULTS: The total CPB and ACC time in minutes for cases 1, 2 and 3, respectively, were: 99,76; 117,68; 143,99. Moreover, Post-implantation Transesophageal Echocardiogram (TOE) demonstrated a well-seated valve, and no paravalvular leak for all cases and a Peak and mean Gradient in mmHg of 12,7 for case 1; 14,8 for case 2 and 17, 7 for case 3.
CONCLUSIONS:Redo-AVR with Perceval is an excellent choice of valve replacement as it can safely simplify challenging cases at risk of PPM and an excellent Valve in Valve (ViV) alternative on degenerated or infected Bentall valve with patent graft. Perceval can seat well on different structures of a degenerated bioprosthetic valve.
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