title: Aortic valve replacement and concomitant procedures with the Perceval valve: results of European trials.
abstract: BACKGROUND
  The Perceval (Sorin Group, Milan, Italy) is a self-anchoring sutureless aortic valve prosthesis. We report the short- to midterm results of combined aortic valve replacement (AVR) with concomitant procedures in elderly patients undergoing operation as part of 3 consecutive prospective multicenter European studies.
  
  
  METHODS
  From April 2007 to February 2013, 243 patients (mean age, 79.7 ± 5.1 years; female patients, 61%; median EuroSCORE, 9%) underwent AVR with concomitant procedures. The concomitant procedures were coronary artery bypass grafting (CABG) (182 cases), septal myectomy (21 cases), CABG + other procedures (18 cases), and 22 other procedures. Primary and secondary end points included implant feasibility and safety (for mortality and morbidity) and efficacy (New York Heart Association [NYHA] class improvement and hemodynamic results) of the prosthesis at the different follow-up periods. Data were expressed as mean ± standard deviation. Kaplan-Meier analysis was performed for survival analysis.
  
  
  RESULTS
  Mean aortic cross-clamp and extracorporeal circulation (ECC) times were 50.7 ± 22.8 minutes and 78.9 ± 32.3 minutes, respectively. Thirty-day mortality was 2.1%. Mean postoperative gradient and effective orifice area were 10.1 ± 4.7 mm Hg and 1.5 ± 0.4 cm(2) and 8.9 ± 5.6 mm Hg and 1.6 ± 0.4 cm(2), respectively, at 1 year. There were early explantations, 4 of which resulted from paravalvular leaks. One additional valve explantation resulted from aortic root bleeding, probably caused by excessively extensive decalcification. In the late period, there was 1 mild paravalvular leak and no intravalvular insufficiency. No migration, dislodgement, or degeneration of the valve occurred during follow-up. Median follow-up was 444 days.
  
  
  CONCLUSIONS
  These trials confirm the safety and efficacy of the Perceval sutureless aortic valve, especially in elderly patients requiring AVR + concomitant procedures. In this patient group, sutureless valves may be advantageous compared to transcatheter valve implantations as concomitant procedures other than percutaneous coronary artery angioplasty are not always possible in the latter.
authors.affiliation: Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Germany. Electronic address: shrestha.malakh.lal@mh-hannover.de.
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.affiliation: Cardiac Medicosurgical Department, Institute Mutualiste Montsouris, Paris, France.
authors.forename: Thierry A
authors.initials: TA
authors.lastname: Folliguet
authors.affiliation: Klinikum Nuernberg, Center of Cardiac Surgery, Nuremberg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Pfeiffer
authors.affiliation: Cardiac Surgery, U.Z. Gasthuisberg, Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Meuris
authors.affiliation: Inselspital, Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Ruhr University of Bochum, Department of Cardiothoracic Surgery, Bochum, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bechtel
authors.affiliation: Cardiac Surgery, U.Z. Gasthuisberg, Leuven, Belgium.
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Flameng
authors.affiliation: Klinikum Nuernberg, Center of Cardiac Surgery, Nuremberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
authors.affiliation: Cardiac Medicosurgical Department, Institute Mutualiste Montsouris, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Laborde
authors.affiliation: Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D013536:Suture Techniques