title: Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes.
abstract: OBJECTIVE
  Prolonged aortic crossclamping can increase mortality and morbidity after aortic valve replacement in elderly and high-risk patients. Sutureless implantation of the prosthesis has the potential to shorten aortic crossclamp time.
  
  
  METHODS
  The Perceval S valve (Sorin Biomedica Cardio Srl, Sallugia, Italy), a sutureless implantable aortic bioprosthesis, was used in 32 patients (median age, 78 years; median logistic euroSCORE, 9.99) requiring aortic valve replacement with or without concomitant coronary artery bypass grafting. Hemodynamic parameters and clinical outcome were obtained at discharge, at 6 months, and up to 1 year postoperatively.
  
  
  RESULTS
  Aortic crossclamp time needed for aortic valve replacement was 18 ± 6 minutes. Hemodynamics at discharge showed good function of all Perceval S valves with low transvalvular pressure gradients (mean, 12 ± 5 mm Hg and peak, 23 ± 9 mm Hg) and low incidence of paravalvular or valvular leakage. Operative mortality was 0%. Follow-up at 1 year showed 3 non-valve-related deaths. Survivors showed good clinical outcome and stable hemodynamic function of the valve prosthesis, except for 1 patient in whom endocarditis developed. Despite a moderate decrease in platelet counts persisting up to 12 months, freedom of bleeding and thromboembolic events was 100%.
  
  
  CONCLUSIONS
  It is possible to implant a well-functioning sutureless stent-mounted valve in the aortic position in less than 20 minutes of aortic crossclamping. This is associated with excellent early clinical and hemodynamic outcome in high-risk patients. Moderate changes in hematologic parameters persisted but were not related to clinical events.
authors.affiliation: Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium. willem.flameng@med.kuleuven.ac.be
authors.forename: Willem
authors.initials: W
authors.lastname: Flameng
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Herregods
authors.forename: Hadewich
authors.initials: H
authors.lastname: Hermans
authors.forename: Gerry
authors.initials: G
authors.lastname: Van der Mieren
authors.forename: Monique
authors.initials: M
authors.lastname: Vercalsteren
authors.forename: Gert
authors.initials: G
authors.lastname: Poortmans
authors.forename: Jan
authors.initials: J
authors.lastname: Van Hemelrijck
authors.forename: Bart
authors.initials: B
authors.lastname: Meuris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D016896:Treatment Outcome