title: Sutureless perceval aortic valve replacement: results of two European centers.
abstract: BACKGROUND
  The Perceval S bioprosthesis (Sorin Biomedica Cardio Srl, Sallugia, Italy) is a self-expanding valve designed to preserve aortic sinuses and sinotubular junction. We report the midterm results of a prospective, multicenter clinical study evaluating the safety and efficacy of this stented bioprosthesis in patients undergoing aortic valve replacement with or without concomitant procedures.
  
  
  METHODS
  From January 2007 to September 2011, a total of 208 high-risk patients (mean European system for cardiac operative risk evaluation: 8.7±5.3 years) received a Perceval bioprosthesis in 2 European centers. Median follow up was 10±20 months and 100% complete, and the total accumulated follow-up was 156 patient-years. Ten patients have reached a 4-year follow-up. Valve function was assessed in all patients.
  
  
  RESULTS
  Valve implantation resulted in significant improvement of patients' symptoms. Mean preoperative and postoperative gradients were 48.6±18.6 mm Hg and 10.4±4.3 mm Hg, respectively, and preoperative and postoperative mean effective orifice areas were 0.7±0.2 and 1.4±0.4 cm2. Survival at 12 months was 87.1%, success of implantation was 95%, and freedom from reoperation was 96%. In hospital mortality was 2.4%. During follow-up, 9 patients (4%) required reoperation for paravalvular regurgitation; 7 early and 2 late reoperations. Mean cross-clamp time (CCT) and extracorporeal circulation time (ECT) were, respectively, 33±14 minutes and 54±24 minutes, including 45 patients who underwent surgery through ministernotomy. Concomitant coronary bypass was done in 48 patients with mean CCT 43±13 and ECT 68±25 minutes.
  
  
  CONCLUSIONS
  Perceval sutureless is a safe bioprosthesis that can easily be implanted, including by a minimally invasive technique. It provides excellent hemodynamic with significant clinical improvement. Overall, these data confirm the safety and utility of the Perceval bioprosthesis aortic valve replacement for high-risk patients.
authors.affiliation: Institut Mutualiste Montsouris, Paris, France. thierry.folliguet@imm.fr
authors.forename: Thierry A
authors.initials: TA
authors.lastname: Folliguet
authors.forename: François
authors.initials: F
authors.lastname: Laborde
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zannis
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ghorayeb
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013537:Sutures; D016896:Treatment Outcome