title: Challenge for perceval: aortic valve replacement with small sutureless valves--a multicenter study.
abstract: BACKGROUND
  There is controversy concerning the performance of small aortic prostheses (size < 21). These have been associated with morbidity and mortality after aortic valve replacement (AVR) due to their increased gradient. Sutureless technology is now available but the performance of the smallest of these prostheses needs to be assessed.
  
  
  METHODS
  The registries of 4 European centers, including 276 consecutive patients (mean age 79.7 ± 5.2 years, 69.9% females), were reviewed in order to compare data on the smallest model of the Sorin-Perceval sutureless prosthesis (Sorin Group, Saluggia, Italy) compared with larger models. The small valve ("S" size) was inserted (S group) in 47 patients, while 229 patients had a larger one (labeled "M" and "L" by manufacturer, herein L group). Except for body surface area (1.60 ± 0.16 vs 1.78 ± 0.19 m(2), p < 0.001), there were no other relevant preoperative differences. The European system for cardiac operative risk evaluation log was 11.4 ± 6.1 versus 12.6 ± 9.6 (p = 0.28).
  
  
  RESULTS
  Median sternotomy was the most frequent approach (S group 87.2% vs L group 79.5%, p = 0.31). The associated procedures were similar for both groups (31.9% vs 34.5%, p = 0.87). For isolated AVR, cardiopulmonary bypass and cross-clamp times were, respectively, 49.1 ± 16.0 and 30.7 ± 9.2 minutes (S group) versus 52.6 ± 23.1 and 32.3 ± 13.6 minutes (L group) (p = 0.33 and 0.45). Hospital mortality was nil (S group) versus 2.6% (L group) (p = 0.62). At discharge, the peak-pressure-gradients were 22.7 ± 7.9 and 20.9 ± 8.4 mm Hg (p = 0.24) while indexed effective orifice areas were 0.84 ± 0.16 and 0.86 ± 0.25 cm(2)/m(2) (p = 0.76). At follow-up (1.5 ± 1.3 years), echo data and survival did not differ (p = 0.17).
  
  
  CONCLUSIONS
  This multicenter study confirms the safety, efficacy, and ease of insertion of Perceval valves in elderly patients with small annulus. The performance of the smaller prosthesis was satisfying and prosthesis size did not affect patient outcome.
authors: Cardiac Surgery Unit, Fondazione Poliambulanza, Brescia, Italy. Electronic address: emmanuel.villa@gmail.com.
authors: Emmanuel
authors: E
authors: Villa
authors: Cardiac Surgery Unit, Fondazione Poliambulanza, Brescia, Italy.
authors: Antonio
authors: A
authors: Messina
authors: Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France.
authors: Francois
authors: F
authors: Laborde
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Medizinsche Hochschule, Hannover, Germany.
authors: Malakh
authors: M
authors: Shrestha
authors: Cardiac Surgery Unit, Fondazione Poliambulanza, Brescia, Italy.
authors: Giovanni
authors: G
authors: Troise
authors: Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France.
authors: Konstantinos
authors: K
authors: Zannis
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Medizinsche Hochschule, Hannover, Germany.
authors: Axel
authors: A
authors: Haverich
authors: Department of Cardiovascular Surgery and Heart Transplantation, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Vandœuvre-lès-Nancy, France.
authors: Mazen
authors: M
authors: Elfarra
authors: Department of Cardiovascular Surgery and Heart Transplantation, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Vandœuvre-lès-Nancy, France.
authors: Thierry
authors: T
authors: Folliguet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D001705:Bioprosthesis; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D061646:Operative Time; D011474:Prosthesis Design / Q000379:methods*; D011475:Prosthesis Failure; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome