title: Minimally invasive aortic valve replacement with Perceval valves: first clinical experience.
abstract: OBJECTIVE
  Although minimally invasive aortic valve replacement (MIAVR) has been shown to cause less morbidity than conventional surgery, it has not yet received broad application. The purpose of this study was to evaluate sutureless implantation using the Perceval S aortic valve bioprosthesis (Sorin Group, Saluggia, Italy) via ministernotomy.
  
  
  METHODS
  Seventy-two patients (43 women, 29 men; mean age 77.4 ± 5.3 years) with isolated aortic valve stenosis (mean gradient of 52 ± 14 mmHg) underwent aortic valve implantation with the sutureless Perceval S bioprosthesis, following cardiopulmonary bypass (CPB), aortic cross-clamping (ACC), cardioplegic arrest and removal of the calcified native valve. The mean logistic EuroSCORE was 9.7 ± 6.2%.
  
  
  RESULTS
  The prosthetic valve was successfully deployed in all patients. Thirty-day mortality was 1.4% (n = 1). Mean CBP, ACC, and implantation times were 68 ± 18, 40 ± 13 and 8.9 ± 4 min, respectively. Perioperative echocardiography revealed significant paravalvular leakage in one patient. Postoperative mean gradient was 11.6 ± 5.1 mmHg. At a mean follow-up of 13 ± 6.7 months, no significant paravalvular leakage or valvular regurgitation was observed, and no migration or dislodgement of the prosthesis occurred.
  
  
  CONCLUSIONS
  This study shows that sutureless implantation of the Perceval S aortic valve bioprosthesis provides a simple and reproducible alternative for MIAVR. As the valve does not need to be sutured, it may also result in reduced ACC and CPB times. This self-anchoring valve may also allow the application of MIAVR to a broader spectrum of patients. This new technology needs a long-term follow-up.
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.forename: Steffen
authors.initials: S
authors.lastname: Pfeiffer
authors.forename: Joachim
authors.initials: J
authors.lastname: Sirch
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Vogt
authors.forename: Giovanni
authors.initials: G
authors.lastname: Concistrè
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D011474:Prosthesis Design; D013536:Suture Techniques; D016896:Treatment Outcome